I’ve just had a look at the 51 referrals I made to secondary care for the last 3 months of 2010. There were 51 referrals out of 807 appointments.
None of these patients were interested in provider choice. In almost every case they had to go through a time-wasting, complicated process called choose and book, and in almost every case they chose the local service.
The government are betting the future of the NHS on patients and doctors being sufficiently picky about their secondary care providers, that the providers are forced to compete on price and quality, driving prices down and quality up. They are betting the future of the NHS on this.
If patients are not picky and GPs choose their local services, there will be no competition, and the fundamental basis of Lansley’s £3bn total reorganisation of the NHS will have failed.
They’ve got less than a week before the Health White Paper goes to Parliament. This would appear to be a fatal flaw.
A Better NHS 
You forget if they leave it to the GP to select someone they want to commission we may well get who is the cheapest and who they know rather than who is the best. Unless Choose & Book and health informatics matures rapidly.