Offer choice or face contract sanctions, GPs told
By Steve Nowottny
Exclusive: Ministers are planning to force GPs to offer patients a choice of hospital at every referral by making it a core contractual requirement, Pulse can reveal.
GPs would not be paid for offering choice, but would have to demonstrate their compliance or face deductions in pay or regulatory action.
The move is one of a raft of measures being considered by the Department of Health amid huge frustration at the floundering of its choice policy.
Bob Ricketts, director of system management and new enterprise at the DH, told Pulse officials were looking at different ways in which choice could be made a contractual requirement. ‘We're exploring how we might do that,' he said.
‘It is about saying to PCTs you've got to take choice seriously. You've got to make sure the public are aware of their rights and if for some reason somebody isn't offered a choice then you need to facilitate that.'
Mr Ricketts said there was ‘a legal duty on PCTs' to chase up and resolve complaints against practices failing to offer choice.
He said PCTs might even have to pay salaried doctors to see patients who reported being denied choice by their GP.
Latest figures show that as of September 2008 just 46% of patients recalled being offered a choice of hospital for their first outpatient appointment.
Department of Health sources privately admit the figure – unchanged since early 2007 – has ‘flatlined'.
David Stout, director of the NHS Confederation's PCT Network, said: ‘The truth is that nowhere in the GP contract is it stated they have to offer choice, so that's where there's a disconnect between the legal rights of the patient and no obligation on the practice.'
GP leaders responded angrily to the plans, and warned ministers to concentrate on improving the mechanism for delivering choice instead.
Dr Rob Barnett, secretary of Liverpool LMC, said: ‘Ramming choice down people's throats is nonsensical.'
‘The vast majority of patients want to go to their nearest hospital. I don't know what needs to be done to get the Prime Minister to understand that.'
GPC negotiator Dr Peter Holden said: ‘Half the reason patients don't get it is because PCTs keep buggering about with Choose and Book.'
Dr Jamie Macpherson, secretary of Coventry LMC, called for the GPC to ‘robustly' oppose any effort to include choice in the GP contract.
‘As long as the system doesn't work, it would be impossible to include it in core services,' he said. ‘The cornerstone of nGMS is no new work without new remuneration. To make it compulsory would involve an increase in global sum.'
Other measures planned to increase patient choice include an expansion of the Partnership for Patients Pilot Programme, in which librarians help patients select and book their appointments, and a national advertising campaign.
‘Life Channel' broadcasts are now in place in more than 4,400 surgeries, and a marketing campaign will target patients at 26 PCTs with stands and trailers outside supermarkets.
An impact assessment published alongside the NHS Constitution reveals promoting free choice could cost as much as £31.9m nationally, or £210,000 per PCT.PCTs have a legal duty to chase up GPs who fail to offer patients a choice of hospital PCTs have a legal duty to chase up GPs who fail to offer patients a choice of hospital How ministers plan to impose choice
• NHS Constitution to make choice a legal right for every patient – and promoting it a legal duty for PCTs
• Department of Health to press negotiators for inclusion of choice within the GP contract
• Extension of libraries project, with patients able to access information and receive assistance in choosing and booking their hospital appointments
• National marketing campaign to advertise right to choice, with ‘Life Channel' broadcasts in thousands of GP surgeries
• PCTs to ensure choice offered at a local level, monitoring complaints from patients