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At the heart of general practice since 1960

Patients snub right to choose hospital

By Steve Nowottny

Exclusive: The Government's flagship drive for GPs to offer patients a choice of hospital is proving irrelevant in many areas of the country, a Pulse investigation reveals.

Just 6.4% of referrals in the past financial year were for patients travelling from outside hospitals' normal catchment areas, with the proportion of ‘out-of-area' patients as low as 3.5% at rural hospitals.

Our analysis of data from 84 hospital trusts in England shows the number of patients exercising the right to choose their hospital has more than doubled since 2004/5 – but from a low base.

And the statistics, obtained under the Freedom of Information Act, reveal there is no correlation between patient choice and clinical quality, with little evidence patients are being guided by ratings of services.

Instead, it appears it is financially efficient hospitals that actively market themselves that have been most effective at persuading GPs and patients to choose their services.

Our most dramatic finding is a sharp geographical divide, with the proportion of patients classed as ‘out-of-area' three times as high at urban hospitals as rural ones. And the total number of referrals has risen twice as fast in urban hospitals as in rural ones since 2004/5.

But the rise in referrals has apparently occurred irrespective of how well, or badly, hospitals have scored in Healthcare Commission ratings.

Mid Staffordshire NHS Foundation Trust, found by a recent Healthcare Commission inquiry to have provided ‘appalling' patient care, saw its out-of-area referrals jump by 122% between 2004/5 and 2008/9, just above the average of 114%.

There was no correlation between Healthcare Commission ratings of clinical quality and the rate of out-of-area-referrals.

But trusts that were actively marketing their services – some with marketing budgets of over £200,000 a year – had a 145% increase in patients travelling to attend, compared with just 65% in those doing no marketing.

The findings sparked a war of words between the Government and the GPC over the future of patient choice. Health minister Ben Bradshaw told Pulse the investigation's analysis ‘suggests patient choice in England is working, which is encouraging as it confirms what we already thought to be the case'.

He played down the significance of the rural-urban divide, adding: ‘It would not be surprising if more people in urban areas are exercising choice, as there is likely to be a bigger choice of hospitals near where they live.'

But GPC negotiator Dr Chaand Nagpaul said: ‘The whole choice agenda is of very little meaning to patients and GPs in rural areas. It's no surprise the quality of hospital and patient flows do not match.

‘We've always argued the Government should put more effort into improving quality of services in hospitals, rather than relying on market forces.'

Dr Mark McCartney, a GP in Pensilva, Cornwall, said distance, transport and parking were the factors most likely to influence his patients' decision.

‘From a rural perspective, the vast majority of patients wish to choose a local hospital, and expect all secondary care to be of a good clinical standard.'

The proportion of patients from outside the hospital catchment area is as low as 3.5% in rural areas The proportion of patients from outside the hospital catchment area is as low as 3.5% in rural areas

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