Choose and Book - peripheral clinics filled with 'CAB Surfers'

Just back from a clinic in a 'community' hospital 30 miles or so from my base. An interesting experience - the building was shiny and new; the X-rays were digitised and viewed on my desktop via PACS (OK, the old films never made it from the base hospital, but still, the male patients liked it). As I'd been told they would be, the clinic nurses were experienced, committed and attentive.

Nine patients to see - the new referral patient was a 'choose and book' whose GP is 200 yards from ... my base hospital. I drove 30 miles (40 minutes) to see a patient who lived very close to the hospital I've just driven out from to do the clinic.

The remainder of the patients I saw at the smaller peripheral hospital lived nearby. It was clearly more convenient for them to see me there, indeed the majority found it very difficult to get to the central hospital and very much appreciated the long-established 'outreach' clinic.

The 'new' patient - who lived 30 miles down the road near my base hospital - had been given the appointment in the peripheral clinic because the waiting list was 6 weeks shorter than that at the central clinic. He had no strong views as to where he was seen, indeed he had to visit the central hospital to get the lab tests done to prepare for the peripheral clinic visit.

Slots in the peripheral clinic are precious. They should be preserved for those who find it difficult to get to the central clinic. I'm afraid I told the 'new' patient that he would be followed up closer to home; of course he was happy with that. It's a shame that the peripheral clinic is filling up with patients surfing the Choose and Book system (a.k.a. 'Booze and Chuck'), using slots which would be better filled by disabled local patients.

Choose and Book (CAB) is not good for the environment. The pressure is on for GPs to get their patients seen as soon as possible. Given the new system, GPs quite naturally opt for rapid review in a distant clinic over a wait in a more local establishment. But the patients who need the peripheral clinics suffer. Think of the 'patient miles'.

The peripheral clinics can't do everything - indeed, there is an argument for scrapping them completely and centralising everything in regional centres. But, if you accept the arguments for peripheral clinics, it makes no sense to have scarce slots occupied by 'CAB surfers'.