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Does offering a choice of hospital benefit patients?

The choice agenda is intended to offer patients a real choice as customers of the NHS. Is it a boon to the patient experience – or do patients not really want a choice, just good local care? Two GPs argue it out

The choice agenda is intended to offer patients a real choice as customers of the NHS. Is it a boon to the patient experience – or do patients not really want a choice, just good local care? Two GPs argue it out



Offering choice not only empowers patients but improves GPs' relationship with them and makes hospitals properly accountable, says Dr Paul Williams

When the idea was first mooted of offering patients a choice of referral destination I was sceptical. I felt it was politically motivated garnish and would be yet another call on my pressurised consultation time. But whatever the Government's motivation in introducing choice, I've been impressed by the positive impact it's had on the referral experience for both the patient and the doctor.

So, why do my patients and I like choice?

Before Choose and Book, referral letters would disappear into the black hole of the hospital appointments department. Nobody knew when the appointment might appear and published waiting times bore no resemblance to the patient experience.

When you use Choose and Book, patients see a list of all the providers and an indicative wait for each. That indefinite period of pregnant anticipation is eliminated. Patient leave our consulting rooms clutching a letter that not only tells them where and when they will be seen, but has even allows them to choose the time of the appointment – a crucial advantage if you work shifts or have children at school.

Patients are able to balance the personal benefits of a shorter wait against the practical inconvenience of travelling further or having to battle a notoriously difficult car park. They may have heard a particular consultant or hospital is good for their problem: Choose and Book allows them to see how long they will have to wait for an appointment with that clinic.

Offering patients choice empowers the patient in a way few aspects of the NHS do. My experience of being a patient or relative is akin to being a piece of flotsam, bobbing on a sea of Government targets that preoccupy hospitals to the extent they forget they are there to serve.

Patients' positive experience of Choose and Book adds lustre to general practice too. Patients are happier with you for getting them the appointment they wanted. I'm more satisfied when I know I've chosen, with the patient, the best option for them. At last, we're able to see if the times patients have to wait are compatible with their clinical problems. If the wait is too long we can contact the consultant to negotiate an earlier slot.

Another benefit for GPs is that we're constantly updated on the services hospitals have on offer. Hospitals used to ‘cold launch' new services they didn't want too many patients to use.

Now services are there on screen the moment they are launched. And GPs can be certain that if we refer a patient to a distant hospital, the PCT or commissioning group will pay for it. In the past I have spent time writing to the trust arguing the merits of an unusual referral request – and all too often had that request turned down.

Offering choice does take more time. It's an extra service, by no means a core duty. If it is to continue it should be funded as at present – we must not be expected to provide the service for nothing. And for choice to be as useful as it can be, hospitals must be fully engaged. One of ours had to be dragged kicking and screaming along the Choose and Book pathway and even now many of its specialties merely pay

lip service to it. But the lack of available appointments at this hospital is obvious to both doctor and patient and causes many to choose alternative providers.

The more of us who use Choose and Book, the fewer referrals hospitals like this will get and they will be forced to improve or lose revenue.

So, yes, offering choice takes more time, but it is rewarding for both doctor and patient. I urge general practice to adopt it universally and the Government not to tarnish the service by making it an unfunded chore.

Dr Paul Williams is a GP is Wisbech, Norfolk


The choice agenda does not provide patients with true input into their care and will disadvantage the poorest and most vulnerable, argues Dr Kailash Chand

Giving patients more choice about how, when and where they receive treatment is a cornerstone of the Government's health strategy. The problem is that asking people if they want more choice is a bit like asking whether they want more peace. Of course patients will say yes – it is an obvious, self-evident truth. But what this simplistic question hides from patients is the multiple subtleties that lie underneath the choice debate.

For although patients may respond that they want choice, it's also true that they want good relations with staff, good-quality treatment, precise information about their care and speedy, efficient resolution of their health problems.

These are all priorities for the public, but the Government's obsession with the power of market forces – which it sees as essential to support its vision of choice – means all the other necessities for good-quality healthcare will be ignored. And, most depressingly, the least well-advised patients could well end up with inferior care.

Turning the NHS into a giant marketplace creates winners and losers. The downside of shopping around is that hospitals that don't attract customers may go bust, which could deny patients the option of a local service.

The Government's idea of patient choice is simplistic, undefined and perhaps not founded on the needs of the individual patient.

Choice may disadvantage the chronically ill and the elderly, who are often not well enough to travel long distances and whose chronic diseases may require multiple visits to hospital.

Instead, the Department of Health sees the choice agenda like a military-style capacity-planning exercise to drive down waiting times. It is difficult to see how the patient has any voice in the complex and highly unaccountable system being put in place.

Most GPs have detailed knowledge of local services and know where, in conversation with patients, their interests are best served. This partnership and trusting relationship between GP and patient has always worked extremely well. But that relationship is being threatened by the reduction in named-consultant referral options, which patients often say are more important than hospital choice.

Hospitals now hardly ever offer a choice of named consultants, because of their fear of long waiting lists for certain specialists. To add further problems, Choose and Book is prone to glitches and if appointments are cancelled by the hospital, people end up having to accept hospitals or times that they did not originally want, which angers them as their much-vaunted choice has been denied.

The direct professional relationships between GPs and local hospital doctors was also crucial to planning local healthcare. This is being corroded – a matter of deep regret for patients and GPs alike.

Ultimately, the Government's politicised form of choice moves us further away from meeting the needs of people from minority groups or those on low incomes, as well as failing to understand a range of issues crucial to good-quality patient care.

Patients don't want a false choice. To promote choice for political motives, the politicians have elevated process over outcomes. What people really want is a good local hospital they can rely on.

They want quality GP services, quality ambulance services to take them to a quality hospital, staffed by quality doctors and nurses in quality time. They don't want to know there is a three-star hospital available 50 miles away. Choice is empty rhetoric and it needs exposing.

Dr Kailash Chand is a GPC member and a GP in Ashton-under-Lyne, Lancashire

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