Using IT to deliver on free choice

The beginning of this month sees a substantial expansion of the government’s policy of patient choice with the arrival of free choice at referral.

Curiously Choose and Book will not be ready to support free choice until 12 days later, with its free choice menus going live on 12 April.

That aside it is clear that free choice cannot be delivered without two key sets of technology – the government’s e-booking system and its flagship website NHS Choices.

Dr Stephen Miller, medical director of Choose and Book, says the e-booking system will be the “simplest and fastest way” for referrers to find the service that patients want.

Choose and Book has been overhauled to deliver free choice with existing functions replaced by two new menus which will enable referrers to either search services commissioned by their PCT using a ‘Search Primary Care’ button or all services provided by acute and foundation trusts and the private sector nationwide by pressing a ‘Search All’ button.

When the new menus take effect on 12 April it will quickly become apparent how well prepared GP practices have been for the change. Dr Miller argues that he and his colleagues could not have done more to communicate the changes with presentations at a range of choice and Choose and Book meetings, a letter to the whole of the NHS and various other initiatives.

However he says: “One concern I have is that come the second week in April people will look at these buttons and say they have never heard about free choice. The system is easy to use provided you understand why there are two buttons.”

For patients NHS Choices has set up a ‘Compare Hospitals’ section which will enable patients to select their procedure, input their postcode and then search for providers with hospitals listed according to distance from the chosen postcode.

A spokesperson for NHS Choices told EHI pPrimary Care: “Patients will be able to compare providers side by side with a scorecard that rates providers on a range of clinical and non-clinical data.”

Waiting times, length of stay, readmission rates, MRSA rates, statistics from Healthcare Commission reports as well as information on such aspects as car parking are all available. In the future NHS Choices plans to build up its patient ratings and add in items such as C difficile rates as well as more information on clinical outcomes.

Whether patients will take advantage of both Choose and Book and NHS Choices to switch providers remains to be seen. Although surveys such as the 2005 British Social Attitudes survey found that 65% of people wanted to choose their treatment and 63% their hospital, it is still a minority of patients (45%) who are aware of their right to choose according to the September 2007 Department of Health National Patient Choice Survey.

However alongside free choice the government has also lifted the restriction on hospitals advertising their services to patients which, together with the addition of private providers to the choices menu, might tempt more patients to switch from their local acute trust.

Even if patients are not quick to take advantage of free choice Dr Miller says the new menus on Choose and Book should be well received by GPs.

He says: “We will be making a lot of GPs very happy because one of the criticisms there has been has been about PCTs restricting referrals via referral management centres. That will no longer be able to happen as GPs will have access to all secondary care services so that should be another positive for the system.”

Other long-standing gripes from GPs about Choose and Book, that hospitals are using it to manage demand by limiting slot availability and that services are difficult to find on the Directory of Services (DoS), may not be so easily resolved by the arrival of free choice

Dr Miller says efforts to ensure providers list their services consistently on the DoS and use the naming conventions agreed at national level continue while the arrival of searching by SNOMED coding is still some months away.

On demand management Dr Miller says: “Trusts should not be limiting the slots to meet 18 week wait but we know that they are and I don’t really know whether free choice will make a difference to that.”

Indeed some fear demand management could potentially get worse under free choice as hospitals struggle to control waiting times in a free marketplace.

Dr Miller remains cautious about whether the popularity of Choose and Book, currently used for around 50% of all first outpatient appointments, will increase with the arrival of free choice. “We will have to wait and see,” he says.

The same almost certainly applies to the whole of the free choice policy. To what extent patients will shop around, its impact on hospitals and ultimately on quality of care all remain to be seen.