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Patient choice ‘destabilising secondary care’

Exclusive: Evidence is emerging that the Government’s patient choice agenda is destabilising secondary care, with inflated waiting lists and warnings that spare capacity could force hospital closures.

CCG leaders say patients are increasingly exercising their choice, with influxes of out-of-area patients causing spikes in activity and longer waiting times at hospitals for local patients.

The choice agenda, first introduced by Labour in 2004 and due to be expanded into new areas by the current Government, encourages GPs to offer patients a choice of provider when referring them for treatment.

A Pulse investigation back in 2009 cast doubt on the effect of the policy, showing that just 6.4% of referrals that year were for patients travelling from outside hospitals’ normal catchment areas.

But board papers from several CCGs reveal real concern in many parts of the country that patient choice is proving unsustainable as NHS budgets tighten.

Harrow CCG in North West London said an audit of antenatal care at the Northwick Park Hospital showed over 40% of local patients were not seen within the set time due to an increase in out-of-area patients, with 27% not receiving an appointment within the set time.

In South east London, Lewisham Healthcare NHS Trust said it had experienced demand above the projected level in maternity and outpatient services in the past year due to patient choice.

A spokesperson explained: ‘The Trust’s market share for maternity service users in Lewisham has increased by 6% in the last two years. With patient choice, many women from outside of the borough choose to birth in Lewisham.’

Councillors are warning in other areas of the country that patient choice is leading to ‘capacity issues’ and the threat of closure in other hospitals.

Earlier this year, neighbouring Bexley CCG reported concerns from Councillor Eileen Pallen that local patients were ‘experiencing long waits for appointments’.  Board papers from the CCG said ‘capacity issues at hospitals resulted from patient choice’.

The NHS South West London cluster, which is currently reconfiguring its hospital services, also had warnings from a local councillor that the St Helier Hospital in Carshalton was ‘likely to close’ as a result of ‘the anticipated adverse impact of patient choice’.

Dr Chaand Nagpaul, GPC negotiator and a GP in Harrow, said: ‘A full choice agenda makes it impossible for local hospitals to plan and make provision for local patients whilst at the same time being available to patients from other areas.

‘It is not appropriate to the choice agenda to be applied in certain clinical areas, such as maternity. There are tensions that need to be addressed. The notion of unfettered choice is a flawed one that does meet the needs or the ethos of the NHS.’

Dr Kamran Ahmed, a GP in Wolverhampton and board member of Wolverhampton CCG, said it was important that choice was used sensibly to keep a lid on demand.

‘There are lots of factors causing change. Obviously if you are a secondary care provider, increasing activity is important to your business. As a commissioner, getting a grip of the activity that’s already there and trying to manage future activity is important to us.’

A spokesperson for NHS South West London attempted to allay concerns over the sustainability of St Helier hospital. They said: ‘No decisions have made yet, but the proposals put forward by local clinicians included a commitment to four sustainable hospitals. The modelling we have carried out on expected patient flows supports that.

The spokesperson added: ‘St Helier was recommended as the location of a new planned care centre for the whole of south west London and that planned care centre is central to the Better Service Better Value proposals.’


Choice puts pressure on services

  • Royal Wolverhampton Hospitals NHS Trust - received more referrals than expected
  • Lewisham Healthcare NHS Trust  - experiencing demand above the projected level in maternity and outpatient services
  • Harrow CCG - audit of antenatal care at the Northwick Park hospital shows 40% of local patients had not been seen within the set time
  • Bexley CCG - long waits for appointments reported
  • NHS South West London cluster – warnings hospital could close