Electronic Referral System (ERS, previously Choose and Book)
Referrals to hospital have to be done through the internet from 2018. This allows you a degree of choice which hospital you want to choose, but it also means you have to make the booking.

You will need to collect the paperwork for the referral from reception and then either log into the internet, or call the booking service to make an appointment.
We have no say about waiting times or availability of appointments, and there seems to be no system that you could complain about it if you cannot get an appointment or a time that suits you or who is responsible. The system is run by NHS Digital.

The booking reference is on the first page.

The password is on the last page.



What is good
You can opt to travel if an earlier appointment is available, and you may be able to book when it suits you best, rather than having an appointment assigned to you. Some private hospitals also have NHS contracts so there is more choice.

What may be difficult
The hospital you choose may not have access to your blood or scan results, or the records of your previous investigations like ECG, EEG, heart or lung investigations or what the specialist was planning to do, what medication you tried before, the reports from the physiotherapy, the accident and emergency, and your old hospital records from other departments or admissions.

We can give you access to your GP records online and you could show this to the hospital or they can log in on your account, but the hospital records are still mainly paper based and the electronic records are not available to patients online. It may mean investigations are duplicated.

Dr Beerstecher's experience - as patient (2018)
In May 2018 Dr Beerstecher was referred to have a spot on his arm removed. He asked for the Will Adams centre as it was easiest to get to, and was given paperwork for a GP clinic in Gillingham or the Somerfield hospital in Maidstone, but not the Will Adams centre. Logging on to the internet and calling the booking service was straightforward and there was not much waiting, however they could not offer more choice, he had to contact his practice again and somehow the option was added. The nearest hospitals and clinics in Sittingbourne were not included in the choice.

Dr Beerstecher's experience - as doctor (2018)
The ERS forces Dr Beerstecher to choose a clinic for you and allows maximum only 20 potential providers. This contravenes the NHS constitution that states you should have unlimited choice. We can not read your mind to know how far you are prepared to travel or how long you are prepared to wait, the possibilities are endless and there is no time to discuss this in your appointment.
It would be better if we did not have to limit your choice, but the system does not allow for this.

The system is confusing, for instance there is a Medway hospital and a Medway Maritime Hospital, some services are listed under one and some under the other, it takes travel as straight line instead of time on the road, so you will get Canvey Island and Southend as choices, even though they are 55 miles away over land. It is not clear whether there are rapid access clinics. Finding a particular specialist or clinic is not always possible as they are not listed on the system.

Waiting times are determined by the third free appointment, but the system is not live. So if three people cancel their appointment, it may show there is only a week waiting, but by the time you try to book it, it may be over 200 days as the three cancellations have been booked but the system has not been updated until overnight and then the same would have happened if another three people cancelled their appointment. The indicative waiting times seem therefore of little value.

If you are booked in the 'wrong' clinic, you may find the appointment has been cancelled by the hospital when you turn up. The specialists only view the letters (likely weeks or months) after you booked and if they do not think you are in the right clinic they may cancel your appointment, however the hospital does not tell you they have done this.

Seeing all the shortcomings it is virtually impossible to do for someone without medical knowledge, knowledge of which clinics are the right ones, and local knowledge about ongoing treatment, yet in all practices the secretaries or reception will pick the clinics and it seems practices normally only give you a choice of maximum 4 and not 20.

Then there are some other limitations that go on hidden from public view: The local health authority may decide you do not deserve to choose your hospital and limits the choice to one. For instance for back pain you are only allowed to go to MSK Clinical Assessment Service, which has escalating waiting times and no back surgeons working for them. However, the other clinics are still visible to us, but apparently if we add these to your choice and you book it, the booking will be cancelled without the hospital informing you of what they have done or why. The same limitations are now in place for eye problems, and this removal of your choice is set to escalate to leave you with effectively no choice.

It is impossible to know all the circumstances of all the patients to help with the selection of clinics, for instance cycling to the Somerfield in Maidstone means going over a large hill, the bus routes to Gillingham do not stop at the Will Adams Centre etc.

Ideally you should be able to see all the options shown to us, then you can order and search for things that matter to you, rather than having restrictions applied. Please contact the NHS if you want to complain about this limitation of 20 clinics or that your choice is being restricted.

The system is so cumbersome that it is not possible to do this during the consultation, meaning you have to come back to the surgery to collect the paperwork another day.

The print-out shows options only in alphabetical order, with no indication of waiting time or distance from your home. You have to log on online or call the booking service to choose your preferences.

See the email correspondence on the right how your choice is restricted -- that is if your condition has not been exclude by the postcode lottery in the first place. Yes, some anonymous authors have created 129 pages of 'exclusions' and maintain that even if virtually everyone has been excluded ("no blanket ban", one person in the UK qualifies) it does not infringe on your NHS constitution right to a comprehensive service. A blanket ban with 1 in 60 million excluded from the ban is not a blanket ban, really?