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GPs must offer more choice for outpatient referrals, Monitor says

GPs should be providing more choice to patients on where they wish to go for their first outpatient appointment, the competition watchdog Monitor has claimed.

Monitor said that the NHS ‘needs to do more’ to let patients know they have a choice in which hospital or clinic they attend, in response to an NHS England survey of 7,000 participants published today that showed that 38% of patients said they had been offered a choice by their GPs.

However, GP leaders said that the reason patients are not offered a choice is usually because there are few outpatient appointments available.

The NHS England survey, which included 2,700 patients who had been recently referred, found that 51% of patients were aware of their right to choose where they attended for outpatient appointments and, where they had been offered a choice, most said they had done so with adequate information (89%) and were able to attend their preferred hospital or clinic (92%).

Patients in London were most likely to be given a choice of hospital, with 47% being offered a choice, but in general patients in rural areas had more choice than those in other urban areas, 45% compared to 36%.

The survey also found that 53% of patients said they had discussed where they would like to attend, suggesting that many patients don’t consider a discussion the same as being offered a choice.

In response, a statement from Monitor said: ‘It is important that, in consultation with their GPs, patients are offered their legal right to choose as set out in the NHS Constitution, particularly given the differences between hospitals on such things as waiting times.’

Catherine Davies, Monitor’s co-operation and competition director, said: ‘Some of these results are encouraging, and suggest that many GPs are having helpful conversations with patients about decisions that affect their care.’

‘But it also suggests the NHS needs to do more to make sure patients are aware they have a choice and are offered that choice. We will continue in our efforts to make sure this happens, and to help patients feel involved and in control of their health care.’

Dr Nigel Watson, chair of Wessex LMCs and a GP in the New Forest, explained that many patients didn’t have a real choice because of where they lived, and said the issue was compounded by the lack of outpatient slots made available on Choose and Book.

Dr Watson told Pulse: ‘Although there is the choice agenda, it’s not quite as simple as you might think.’

‘Some of the time some of the services, despite what is said, there isn’t choice. If you work where I do: in the New Forest, we’ve got three hospitals within a 20 mile radius. If you work in central Southampton, there’s basically one hospital.’

He added: ‘I think it’s more that patients should be aware of their choices. If they want to go further afield they need to be able to have that discussion with their GP. It would help if Choose and Book would work.’

Dr Siraj Shah, a GP in Gateshead, Kent, told Pulse that patients were more concerned about getting treatment quickly, than choice, and that competition rules meant GPs couldn’t honestly advise on the quality of clinics.

Dr Shah said: ‘I think this business of choice is nonsense; I’ve never had a patient tell me “could you refer me here, could you refer me there”. What they want is treatment as quick as possible, delivered local to where they live.’

‘With this business of providing access to AQP [any qualified provider] it is just a nightmare for us. It has created an enormous workload for GPs and we don’t have any idea what quality these people are going to offer.’

‘I remember, a few months back, we had a letter from the area health authority that they have had issues with the quality of one of the AQPs,I don’t remember exactly, but they were serious issues and they withdrew that [contract].’

Readers' comments (11)

  • If there was any choice we would do.Incredible London centric where they have a greater provider density than the rest of the country.

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  • Fully agree with previous comment, this has always been a London policy where they have a choice of many hospitals close by and a massive public transport system. For too many years, NHS policy and silly schemes have been driven by London commuter needs alone, taking no account of the majority of the country. Where I live I want to go to the hospital in my town, not the next nearest 10 miles away or the next nearest after that 40 miles away.
    Come on GPC, where are you, start hitting these stupid quangos hard over the head with the reality of life for the majority of the country, who don't live in London.

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  • Sc@w choice!

    Patients are so restricted on being referred due to CCG guidelines about what will be funded, they just want a referral and care to be provided by any competent hospital.

    Instead no funding for routine things like cataracts until patients nearly blind, no IVF unless you fulfil 47 criteria etc.

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  • Choice would exist if there was a national contract between all the secondary and primary care.

    I was recently called by the CCG finance officer after referring a patient to neighboring region. Their colorectal department charges over 8 times the local tariff for both initial appointment and follow-up for out of area referral. It's clearly a rip off, there is no justification to charge almost 1k for 30 min appointment.

    Shame on you. But until this is addressed, there will be no choice.

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  • This comment has been moderated.

  • This is all very well but where do you get any information on individual consultants (and hospitals) and who has the best outcomes for a particular procedure?
    Until this information is available to all there will not be choice.

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  • The important thing with an impending general election is for us to maintain the illusion of choice for our political masters.

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  • I have ten minutes a patient. By the time I have established the patient needs a referral there are no more minutes left, to have a protracted conversation about the merits of different hospitals.

    Also, as a GP I do not know the details of opd waits or mrsa results etc for each hospital . I do not have anymore time to look them up.

    Time is inelastic. Which bit of ' GPs are overworked ' do they not understand ?

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  • patients are always given the choice in our surgery via the choose and book-can monitor provide the transport to remote places even to london from thurrock-please get real

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  • I fully agree with the coment 10.54. but in my experience most pts want to be seen quickly and do not have to travel too long distance

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  • I work in the middle of a deprived inner city in the north.

    There isnt the transport links nor the duplication of services like in London and the south.

    My patients dont care where they go as long as its soon and the quality is good.

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