Patient choice

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Patient choice is a concept introduced into the NHS in England. Most patients are supposed to be able to choose the clinician whom they want to provide them with healthcare and that money to pay for the service should follow their choice. Before the advent of the internal market, in principle, a GP could refer a patient to any specialist in the UK. When contracts were introduced in 1990 these were called extracontractual referrals. From 1999 the concept of Out of Area Treatments was developed. These referrals were not necessarily related to choice made by a patient. Specialised treatments were not, and are not, available in every area. [1]

Contents

The regulations provide that a patient can choose to be seen by any NHS trust, public body, commercial organisation or third sector body, provided it holds a “commissioning contract” either with NHS England or a Clinical Commissioning Group when they are referred by their GP, community dentist or optometrist for treatment that is not identified as being immediately required. [2] The Government’s mandate to NHS England for 2016-17 issued by Jeremy Hunt specifies “We want people to be empowered to shape and manage their own health and care and make meaningful choices, particularly for maternity services, people with long term conditions and end-of-life care”. [3]

History

Exceptions to policy

Around 80% patients referred by their GP to a first outpatient hospital appointment were eligible to choose the hospital. There are however some exceptions to hospital choice policy. These exceptions include those where speed of access is important such as suspected cancer 2 week wait referrals and urgent referrals such as suspected stroke and heart attack. Referrals to mental health and maternity services were excluded from the policy until April 2014. [5] Patients who are detained, and serving members of the armed forces are not entitled to exercise choice.

NHS Constitution

The NHS Constitution includes a right to choice. It states: You have the right to make choices about your NHS care and to information to support these choices. The options available to you will develop over time and depend on your individual needs. It also repeats the requirements specified in the GP contract: You have the right to choose your GP practice, and to be accepted by that practice unless there are reasonable grounds to refuse, in which case you will be informed of those reasons. You have the right to express a preference for using a particular doctor within your GP practice, and for the practice to try to comply.

CCG and NHS England are required by the regulations to “make arrangements” to give effect to the right of patients to exercise their patient choice. It is for the clinician making the referral to decide whether it is clinically appropriate. The right to choice only extends to a first appointment. It does not imply that any chosen treatment must be paid for. That would depend on the terms of the provider's contract.

Spire Healthcare complained to Monitor (NHS) in 2013 that the Clinical Commissioning Groups in Blackpool, and in Fylde and Wyre were not doing enough to encourage patient choice, but their complaint was dismissed in September 2014. [6]

Comparing hospitals

It is intended that patients can choose the hospital they are seen in by comparing clinical quality, waiting times, location and other patients' opinions. In order to enable patients to compare and choose hospitals the national NHS website established a hospital comparison tool. [7] The information that users can access to compare hospital performance can include:

Using the hospital comparison tool is supposed to be quite simple. Users enter their postcode and the condition that they are being referred for.

Booking appointments

IN 2005 an electronic booking service known as Choose and Book was introduced across the NHS in England. This service enabled GPs and patients to shortlist a list of clinically appropriate hospitals for the patient to choose from, and lets the patient make appointments with hospitals either online or over the phone. Choose and Book was based around Directory of Services which includes the majority of NHS hospital services for GPs to shortlist for their patients to choose from. GPs were given financial incentives to use the system [8]

Choose and Book was replaced by the NHS e-Referral Service in June 2015.

Maternity services

The 1993 report, Changing Childbirth, called choice, control, and continuity of carer for the mother as the most important tenets of maternity care, but its recommendations were not delivered. [9]

Baroness Cumberlege conducted a review of maternity services for NHS England in 2015. Better Births, the report of the national maternity review recommended that all women should have the choice to give birth where they want, with the support of the same midwife throughout pregnancy, labour and the early weeks of motherhood, with control over a personal maternity care budget of £3,000 to be spent on the NHS care they choose. This would be driven by a personal care plan, updated during pregnancy. Every woman should have an electronic patient record which they can access and add to. [10]

Performance

The proportion of patients who reported that they were offered a choice of provider rose steadily until 2010 when 32% of those responding to the inpatient survey reported that they had been offered a choice. By 2013 the proportion had fallen to 27%. [11]

See also

Patient participation

Related Research Articles

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References

  1. ↑ Beecham, Linda (27 June 1998). "Out of area treatments will replace ECRs". British Medical Journal. 316 (7149): 1988. doi:10.1136/bmj.316.7149.1988. PMC   1113431 . PMID   9641962.
  2. ↑ "The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012". Legislation.gov.uk. HMG. Retrieved 21 January 2017.
  3. ↑ "The Government's mandate to NHS England for 2016-17" (PDF). Department of Health. January 2016. Retrieved 10 January 2017.
  4. ↑ "Interim Guidance: Implementing patients' right to choose any clinically appropriate provider of mental health services" (PDF). NHS England. Retrieved 21 January 2017.
  5. ↑ "Mental health choice guidance published". NHS England. 19 December 2014. Retrieved 10 January 2017.
  6. ↑ "Private firm loses NHS choices case". Blackpool Gazette. 27 September 2014. Retrieved 28 September 2014.
  7. ↑ "Hospital location search - NHS Choices". Nhs.uk. Retrieved 2017-01-19.
  8. ↑ "NHS e-Referral Service - NHS Digital". Chooseandbook.nhs.uk. Retrieved 2017-01-19.
  9. ↑ "Changing Childbirth again? Implications of the NSF". Royal College of Midwives. April 2005. Retrieved 12 January 2017.
  10. ↑ "National maternity review calls for £3,000 'birth budgets'". Guardian. 23 February 2016. Retrieved 11 January 2017.
  11. ↑ "Progress on choice of provider has stalled, figures show". Health Service Journal. 21 August 2014. Retrieved 28 September 2014.
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