Public supportive of moves to increase choice but government must do more to make it a reality

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People are supportive of government moves to increase patient choice but insist it can only be made a reality if they can call on advice from their family doctor, if they have more information and if there is more capacity in the system.

These are the main findings of a new King's Fund report, Public Views on Choices in Health and Health Care: A qualitative study, based on a Pfizer initiative, which captures the public's views on the government's flagship health reform. The study comprised nationwide focus groups conducted between June and July this year. Participants were enthusiastic about having more choice and welcomed moves to increase the number of health care providers they are able to choose from. However, some feared that systems for extending choice would create extra work for NHS staff and might divert money that could better be spent on improving existing services.

Among the key findings of the report are:

  • The doctor/patient relationship as key source of information

    Many participants viewed choice as complex and said they would find it hard to get hold of the information they wanted and would need the advice of their family doctor or another health professional to help them understand different choices available. Until more information is widely available, along with appropriate support from a health professional to interpret it, people felt that more choice would not represent real choice for them. Many people also said they preferred to leave health care choices to expert health professionals.

  • Capacity

    The focus groups highlighted real difficulties in choosing between GPs because there are too few in their area and continued problems in choosing convenient appointment times. They also felt that choices other than where to have a planned operation might never materialise because of a lack of capacity in other services. There was receptivity to the idea of new providers and easier access to healthcare professionals, but some concern that this could increase the number of people coming forward for advice on minor ailments.

  • Long-term conditions

    Participants with long-term conditions valued the continuity of being able to see the family doctor or practice nurse that was most familiar with their condition, but they were also interested in having greater choice of provider. Many felt the current reforms do not cater for them as well as they do for people unaffected by chronic illness, and that choices for them might well be limited by cost. These patients were also attracted to the idea of rapid access to specialists which would allow them to bypass their family doctor.

The report comes ahead of the forthcoming government White Paper on health care outside hospitals which is likely to see the introduction of market-style incentives into primary care and a greater role for non-NHS providers in delivering a range of primary care services. It also comes ahead of the Department of Health's target that all patients can choose between four to five healthcare providers for elective hospital treatment by December 2005.

Report author Dr Rebecca Rosen of The King's Fund said:

'The focus groups show that people value choice and want more of it in health. But they also highlight a series of tensions the government must take on board ahead of its health care outside hospitals White Paper. The key is to make the choice policy meaningful by providing people with information about different services and ensure they can obtain advice from health professionals on how to interpret it. The emerging market in primary care will also have to support continuity between patients and clinicians if it is to respond effectively to people's needs, especially those with long-term conditions. It will also be important to maintain a watching brief on the impact this policy has on equity of access to health care.'

Owen Smith of Pfizer UK commented: 'We believe that choice is a good thing and that patients and healthcare professionals should be at the heart of developing the agenda. This report allows us to hear views from the sharp end. It identifies some important themes around the need to invest in quality and access to care, particularly for patients with long-term conditions. We will be delighted if these findings help to move the debate forward'

Read the report: Public Views on Choices in Health and Health Care: A qualitative study

Notes to editors

  1. For further information, interviews or copies of the report, please contact the King's Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185. Alternatively, please contact Sally Goodenough in the Pfizer Press Office on 01737 331537 or
  2. The report, Public Views on Choices in Health and Health Care: A qualitative study, by Rebecca Rosen, Natasha Curry and Dominique Florin, is free to download from Monday, 31 October 2005. Media can obtain hard copies of the report in advance of the embargo by contacting the King's Fund media and public relations office.
  3. The King's Fund ran ten focus groups based on a Pfizer initiative to explore public attitudes to choice in health and health care. The groups were held during June and July 2005, with participants drawn from all age groups and recruited from urban and rural environments in England, Scotland and Wales. They explored people’s recent experiences of choice in relation to health care, how they go about making choices, and the kind of information they would like to support them. The focus groups also explored areas of choice that do not yet exist in the UK – most specifically the use of direct payments and the ability to choose to go directly to a specialist without first seeing the GP. The findings will feed into a larger quantitative survey about choice, which is being carried out in partnership by Pfizer, the King's Fund and MORI, the market research company. This will be conducted towards the end of 2005.
  4. The King's Fund is an independent charitable foundation working for better health, especially in London. It carries out research, policy analysis and development activities, working independently, in partnerships and through funding. The King's Fund is a major resource to people working in health, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.
  5. Pfizer, with its UK business headquarters in Surrey and global headquarters in New York, is a research-based global pharmaceutical company. Pfizer discovers, develops, manufactures and markets leading prescription medicines for humans and animals, and many of the world's best-known consumer treatments. Every month, over two million patients in the UK are prescribed a Pfizer medicine. It is estimated that on any given day, 40 million people around the world are treated with a Pfizer medicine.

Pfizer is committed to creating healthcare partnerships to provide better health outcomes for all. Pfizer is involved in this area as it is keen to help policymakers understand what the public really wants from primary care, especially those people who have long-term conditions.