Black attacks Choose and Book

Choose and Book has reduced healthcare to a factory production line that is detrimental to patient care, the president of the Royal College of Surgeons has claimed.

John Black said the traditional system meant patients were referred from their GP to a single consultant, who would then oversee the whole process of care from initial consultation to final discharge.

Writing a viewpoint for the BBC website, he argued that direct professional relationships between GPs and local hospital doctors were vital and that they enabled GPs to select the right consultant for each patient, based not just on the type of operation required and technical competencies of the surgeon, but also on personality.

He said: “This cord between GPs and surgeons has been cut by the computerised Choose and Book system, which purports to offer greater patient choice but which has had the opposite effect.”

However the Department of Health claimed that while GPs' knowledge of local service would always be invaluable, the public expected and welcomed choice.

In a statement, it added: "Rather than forcing patients and their doctors apart, Choice allows patients to be active participants in their healthcare alongside the guidance of their GP. Choice has also helped drive up standards across the NHS in England."

The ability of GPs to refer to named consultants using the Choose and Book system has been the subject of some dispute in the NHS. The Choose and Book national team is encouraging hospitals to include named consultant referrals wherever possible on the Directory of Services, but some hospitals have so far opted not to do so, leaving some GPs to use a paper referral to an individual doctor.

Black argued that patients may not know enough to make an informed choice and instead welcomed advice and input from their GP and the opportunity to be seen by just one consultant.

He added: “You might be seen initially by Consultant A, come back for your results to see Consultant B, go on to a common waiting list and then have your actual operation done by Consultant C, whom you might meet for the first time on the morning of your operation.

You may well be sent home the following day by Consultant D and if you are fortunate enough to have a follow up consultation, you may be seen by consultant E.

Mr Black called for it to “again be the norm” for patients to be referred to an individual consultant who would be responsible for their care throughout the clinical episode.

He added: “Using the latest technology to increase the efficiency of the health service and measure how patients' lives are improved is vital.

But this must be sensitive to the individual patient and must retain personal professional judgement. The current system in the NHS is forcing patients and doctors apart and I believe the delivery of care is poorer without those personal relationships.”