Choice move

It is now a few weeks since my PCT introduced its new direct cataract referral system under the Government's Choose and Book scheme. I now not only have the responsibility to decide if my patient has a cataract that is suitable for surgery but I am now also considered responsible enough to assist my patient with their choice of where to have this procedure carried out. I am also paid to offer this choice!

It is easy to be cynical about these systems as they come on stream but I can honestly say that I do feel this is a positive step forward. Of course our GPs are not all happy about it. Some feel they should be paid for offering the choice and refuse to co-operate because they are not receiving any funding.

There is something vaguely warming when I hear these protestations. For how long have we found ourselves doing the shouting? I almost find myself feeling like a mature professional clinician!

However, all is not as perfect as it may seem. I only get to offer a choice of two hospitals and the amount of paper that this basic choice seems to generate is immense. It became clear to me very early on that the concept of Choose and Book, while being a good one, is totally unworkable in any sensible format that relies on a paper-based system. Not only is it time-consuming to fill in the paperwork, it is also laborious to save and cumbersome in its delivery to the correct parts of the system.

Just after introducing Choose and Book I attended a demonstration of the computer-based system that will supposedly support this nationally. I was impressed with the thinking behind the system, but when I witnessed it in operation the story of the emperor's new clothes came to mind.

There are many people working on the computer system to run Choose and Book and they will all tell us how fantastic it is and how well it works, but when it is seen live these glowing reports just do not stack up.

Now is not the time to go into the many faults. I just want to pick on the most glaring fault as it affects optometrists. Under the full Choose and Book system the patient, at the outset of the referral process, will be issued with a unique identifier number by the referrer. This code number is generated by the system itself. It cannot be generated manually and this is the vital point. If optometrists are not connected to the computer system they just will not have access to these uniquely generated numbers and therefore will not be able to refer patients directly or offer choice.

This means that all the embryonic good works that are now operating will have to cease unless PCTs are made to understand the ramifications of only connecting GPs to the new system. If we are to continue with the advance that Choose and Book has given us, our national bodies must be making this message heard loud and clear at the Department of Health.