How do referral caps fit in with patient choice?

In recent weeks many of us practice managers have been sent guidelines of new referral processes for our respective areas. In essence these processes are aimed at reducing referrals into secondary care by either managing referrals before they reach the hospital consultants by an intermediary service or by setting a quota on referrals. These policies appear to be diametrically opposed to patient choice.

Can you imagine a GP having to weigh up whether they should refer a patient not based on clinical need but on whether they have used up their quota. It also does not sit comfortably with me that every referral (oh sorry not the urgent ones) have to go through an intermediary, correct me if I am wrong but does this not go smack in the face of patient choice, only a year ago at the time of unveiling the NHS constitution we were told that patients had the right to be referred to their provider of choice. How can a GP now book a patient via choose and book at their hospital and time of choice if they have to jump through these new hoops?

Leaving aside our opinions about patient choice for a minute, why can we not stick to a policy for more than a month without changing it? Has anyone ever calculated the cost of distruption everytime a change of focus is decided?

We all have a role to question and challenge any change of policy being presented, at the end of the day it is those at the coal face who really know what matters to patients.