King’s Fund hears more C&B grumbles

Patients value having a choice of hospital but GPs and providers have complaints about the way Choose and Book works to deliver it, according to a report from the King’s Fund.

The health policy think-tank examined how free choice of provider was working in four health economies in England between August 2008 and September 2009.

Its report, ‘Patient choice: how patients choose and providers respond‘, concludes that the system has yet to act as a lever to improve quality and increase competition.

The research was based on interviews with GPs, senior executives in hospitals and patients, plus patient questionnaires.

It found that 75% of patients want to choose where they are treated, but only around half recall being offered a choice by their GP. Few (8%) recall being offered the choice of a private provider.

The King’s Fund said that most patients remained loyal to their local hospital (69%) but having a previous bad experience of their local hospital was a major reason for choosing to look elsewhere.

Only 4% of patients consulted NHS Choices to inform their choice of hospital, with most preferring to rely on their own experience or the advice of their GP.

On Choose and Book, the report says a few of the GPs interviewed saw benefits in giving patients greater control and certainty.

However, “technical issues, inability to refer to a named consultant, increased consultation times, lack of directly bookable appointment slots and inaccurate and inconsistent information in the directory of services” were all raised as issues.

The report warns that many GP practices remain reluctant to use the system and some said they would stop altogether if the incentive they were paid for using it came to an end.

The report says hospital providers complain about inappropriate referrals and the difficulty of operating the electronic appointments system while delivering care within the 18 week referral to treatment time target.

The King’s Fund, whose report is published jointly with the Picker Institute, RAND Europe and the Office of Health Economics, concludes that if Choose and Book is to be more widely used, continued improvement will be needed in the system.

It also says there will need to be more training in its functionality. Improvements will be particularly important if local incentives are dropped.

The research also found more fundamenal problems with choice. It found that while GPs broadly supported the idea of patient choice, many underestimated its importance to patients, distrusted comparative performance data, and felt unable to advise patients on referrals outside their local area.

It also found the main focus of competitive activity among providers is securing GP referrals rather than directly competing for patients, which is only happening at the boundaries of catchment areas.

However, the research debunked the idea that choice is only important to young, educated patients. It found that older patients, those from mixed or non-white backgrounds, and those with no qualifications were more likely to think that having a choice was important.

Anna Dixon, director of policy at the King’s Fund and the report’s lead author, said choice was having an indirect effect on quality by motivating providers to maintain their reputation to avoid losing patients.

However she added: “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.”

Link: Patient choice: how patients choose and how providers respond