Findings
The final report of this project Patient choice: How patients choose and how providers respond was published – jointly with the Picker Institute, RAND Europe and the Office of Health Economics – in spring 2010.
Since January 2006, patients requiring a referral to a specialist have been entitled to a choice of four or five providers. And from April 2008 that choice has been extended to any eligible NHS or independent sector provider in England – so-called ‘free choice’. The new report assesses how patient choice is operating based on research with patients, GPs and hospital providers.
The report findings
The research found that:
- while 75 per cent of patients want to choose where they are treated, only around half recall being offered a choice by their GPs
- only 8 per cent of those offered a choice recalled being offered the option of choosing a private provider
- most patients remain loyal to their local hospital (69 per cent choose to be treated there)
- previously having a bad experience of their local hospital is a major reason why patients choose to access care from an alternative provider
- few patients are making use of performance data to inform their choices – just 4 per cent of patients consulted the NHS Choices website – with most preferring to rely on their own experience or the advice of their GP
- GPs said they were offering choice routinely but there was rarely a meaningful discussion of the options available
- patients living in non-urban areas were more likely to be offered a choice and to choose to travel beyond their local provider than those in urban areas
- older patients, those from mixed or non-white backgrounds and those with no qualifications were more likely to think having a choice is important.
The report shows that choice is not yet acting as a sufficiently strong lever to improve quality or increase competition, as the policy intended. The main focus of competitive activity among providers is securing GP referrals rather than directly competing for patients, and this really occurs only at the boundaries of their catchment areas. Interviews with providers revealed that in many cases they are choosing to co-operate rather than compete with each other.
Our conclusions
Anna Dixon, Director of Policy at The King’s Fund and the report’s lead author, said:
‘Patients clearly value choice, even if in most cases they prefer to stay with their local provider. Choice does appear to be having an indirect effect on quality by motivating providers to maintain their reputation in order to avoid losing patients. But the reluctance to implement choice among GPs and little use of performance data by patients suggests there are still a number of significant challenges that need to be overcome if the policy is to be implemented as policy-makers originally envisaged.
‘While it is still early days, we are some way from realising the vision of choice acting as a lever to improve quality, with informed patients choosing the highest performing providers in a competitive market.’
