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GPs not providing enough choice, regulators claim

GPs aren’t giving NHS patients enough choice about which hospital or clinic they are referred to, claims a survey by the regulator of health services and NHS England.

NHS England and Monitor’s annual survey into patient choice found that 40% of the 2,700 respondents said they were offered a choice of hospital or clinic for their first outpatient appointment by their GPs, up slightly from 38% last year.

Monitor said there was ‘more the NHS can do’ to offer patients choice.

However, the GPC said workload pressures meant GPs have ‘limited time’ to discuss referral options, and some CCGs were restricting referrals.

The survey indicated that, when patients are offered a choice, they’re much more likely to be able to go to the hospital or clinic they want (91% compared to only 41% of those who weren’t offered a choice).

Other findings include:

  • People living in rural areas were more likely than those living in urban areas to be aware of their right to choose (52% versus 46%) and to be offered a choice (42% versus 39%).
  • 47% of patients were aware of their right to choose a hospital or clinic for their outpatient appointment, which has decreased from 51% last year.
  • Two-thirds of young people (18- to 25-year-olds) weren’t offered a choice (64%), but those that were offered a choice were the most likely to engage with their GP and discuss where to go (79%).
  • Among those who were offered a choice of where to go for their first outpatient appointment, almost nine in 10 (88%) said that they had enough information to help them make their decision.

Catherine Davies, Monitor’s executive director, co-operation and competition, said: ‘We think it’s only right that patients are in the driving seat when it comes to making decisions that affect their health, and this shows us that GPs are continuing to have helpful conversations with patients and offering more choice. But there is still more the NHS can do to make sure patients are aware of their legal right to choose and are able to make a choice.’

Dr Richard Vautrey, deputy chair of the GPC, agreed that it was important to give patients choice about where they are treated. But he also said that the record number of patients GPs are dealing with can mean that they have limited time to discuss where to refer them, particularly with older patients.

He added: ‘Many of these cases are complex as older patients often have several conditions that leave limited time for discussion about referrals, not least as many patients still prefer to go to their local hospital. Some CCGs are also restricting GP referrals to cut costs, which further constrains the options available for both GPs and the public.’

Longer appointments with patients would give GPs more time to discuss which hospital they want to go to, he said.

In April, a BMA survey of 15,560 GPs found that only one in 10 felt that the current 10-minute appointment slots were long enough.

Readers' comments (10)

  • Vinci Ho

    Again , those politically correct words , choice , competition . Can anyone give a proper definition of 'choice'? And what is the impact of not having these choices in these referral scenarios?

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  • Is it okay for a patient to choose a more expensive option?

    Our CCG wants us to send carpal tunnel operations to the nuffield, because they charge less than half the price of the NHS hospital.

    That is what I do (unless they need a GA or something). Should I be giving the patient the choice of spending twice as much money for the same proceedure?
    Should I be giving them the choice of fluoxeting or branded prozac?
    Should I be giving them the choice of an out of area hospital?

    Someone needs to decide which way around it is. If patients have the choice, then the budget has to be uncapped.
    If GPs are forced to keep within a budget then patient choice needs to be capped.
    Simples

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  • referring to london hospitals from my area carries heavier tarriff than local / hospitals slightly up northwards.

    all dermatology referral now has to go through a hub who screens it. some are seen in community even if pt wanted hosp referral. similar for MSK service.

    Next time I will state 'pt chooses to be see by Orthopaedic cons' rather than ESP/GPwSI.


    same regulators will then rev KPI, referral budgets etc and hammer you with it.

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  • It does seem like the NHS is in a hopeless theoretical muddle here.

    On the one hand, the idea of "choice" is trumpeted.

    On the other, a plethora of formularies, guidelines, restrictions and pathways (MSK triage for orthopaedics?) progressively reduce the actual choices available.

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  • What are the choices left?

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  • If they choose surgery in a far distant hospital who is responsible for organising local care and follow up, certainly not the GP

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  • In order for Choice to be possible there has to be excess capacity (i.e. waste). In a cash-strapped NHS choice is an unaffordable luxury.

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  • Can't refer out of area because the referrals are rejected because they are out of area. So much for patient choice then.

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  • Maybe NHSE can explain why they don't pay deprivation and rural payments to some Practices as calculated on OepnExeter statments while others are paid.
    Practices not paid include ones with 10% list size of depression and highest concentration of learning disablities.
    How can you trust surveys done by absolutely opaque Agencies ? No transparency in fanances whatsoever. And Cameron loves it this way.

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  • Oh, stop it you silly, out of touch organisations. The NHS is collapsing all around us and all you worry about is.... choice?

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