Choose and Book should be scrapped and outpatients could be reduced by 50%

There’s nothing like a good bold assertion to start a debate. Martin Roland, our CCHSR co-director, and  Sam Everington, general all-star GP, have made some rather dramatic suggestions and claims in the HSJ this week. They think that the present referral system is an archaic hangover from 1948 which services the needs of neither GPs, nor specialists, nor patients. What is apparently needed in its place are radically different ways of communicating, so that a named specialist in the first place receives the problem (electronically) from the GP. He or she then takes immediate responsibility for the problem, may phone the GP to discuss the patient, email the GP with advice, arrange a video/telephone conference with the patient and/or GP, pass the referral to a more appropriate specialist, ring the patient and book them in for an investigation, procedure or even an operation, and as a last resort book them to be seen in out-patients. This is starting to happen in Tower Hamlets, and Everington reckons it could cut outpatient visits by 50%.

Whilst all these changes were happening, a few other things might need to be scrapped as well if it was all going to work smoothly. They argue that payment by results for outpatients needs to be replaced with capitated funding, so that hospital trusts have an incentive to support primary care, use modern communication methods and take some responsibility for the whole patient pathway. Doctors would have to work differently too, making time within the working day for contact between GPs and specialists, and specialists need to spend more of their time supporting primary care teams in the community. Some of this is happening already in the ‘new models of care’ Vanguards, and Roland and Everington point to other examples where GPs and specialists are starting to work with each other in quite different ways.

These would all be radical changes. And as with other big cultural changes, some headspace needs to be created in the working day so that staff in the NHS have time to innovate or there is the risk that the hamster wheel will just keep going round and round. Exciting suggestions indeed.

If you have subscription to HSJ, you can read the full piece here. Apologies to other folks!

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