The Government today announced the ‘largest patient choice expansion in a decade’, focused on out-of-hospital care – however GPs have suggested the plans are misguided.
Under the plans, patients will have more options for where they receive out-of-hospital care, with the Department of Health and Social Care stating examples including hearing aid care; some diagnostic tests, such as endoscopy; dietetics and nutrition; ambulatory ECG (heart activity); and podiatry.
NHS England will also encourage ICBs to consider expanding the range of providers of services already covered by existing choice regulations, such as mental health.
Patients will be able to choose between multiple providers ‘across the NHS and independent sector’, the DHSC added.
Patients can already choose where to receive care when referred to an in-hospital service, being given a choice of five providers after consultation with their GP. But NHS England has now been asked to instruct ICBs to pilot the same model for out-of-hospital services.
Asked what role GPs will have to take, the DHSC said ICBs will inform them in due course.
But GPs who Pulse spoke to about the plans were sceptical of whether they were necessary, with some also raising the risk of unintended GP workload increases as a result.
Lancashire GP partner Dr Ann Robinson told Pulse that she felt the plans are trying to solve ‘a problem that isn’t there’.
She said: ‘Patients want local services close to home. Waiting times for the listed services are inconsequential.
‘We need shorter waits for respiratory, cardiac, and neurological outpatients. Locally we currently have waits of over 12 months for neurology outpatient clinics – imagine waiting for a diagnosis of Parkinson’s disease or multiple sclerosis for 12 months.
‘Giving choice for a few small services won’t help anyone and will just make it more difficult for GPs as we often wait longer to get information from non-local hospitals and it makes everything less joined up.’
Professor Azeem Majeed, a GP and head of the Department of Primary Care and Public Health at Imperial College London, said that patients generally prefer shorter waiting times rather than more choice.
He said: ‘The NHS has tried numerous time over the last 30 years to give patients more choice of specialist services. Hence, this current initiative is not novel and we have seen many similar attempts over the years.
‘My experience is though that patients generally want rapid access to high-quality local services rather than more choice of provider.
‘Given the current waiting times for many NHS treatments, I think this remains the case with patients generally preferring shorter waiting times rather than more choice.’
And London GP Dr David Mummery said that ‘very long’ and ‘needlessly complicated’ referral forms as well as referral rejections which could potentially come with the plans would add to GP workload.
He told Pulse: ‘How will it work practically? The reality is that quite a lot of referrals do get rejected, and most patients do not want to travel far and wish to be seen at local hospitals and clinics.
‘I don’t want to be too sceptical, but I would say the Government rhetoric about patient “choice” often bears little relation to the practical realities of referral.’
DAUK spokesperson Dr Lizzy Toberty told Pulse: ‘Anything that improves patient choice and helps them to take control of their care is a positive step, but my concern is that [the DHSC] are struggling to get a handle on the real issues, and are not meaningfully tackling the desperate funding and staffing shortages.’
Health secretary Victoria Atkins said: ‘Empowering patients to take control of their own healthcare decisions is a key part of my missions to make the NHS faster, simpler and fairer for everyone that uses it.
‘Expanding patient choice will enable people to choose when, where and how they are treated – putting power in the hands of the patients.’
NHS national elective recovery director Sir James Mackey said: ‘Giving patients greater choice over where and how they receive their care is a vital part of NHS plans to recover and reform after the pandemic, with patients across the country already able to choose where they receive planned care including surgery, with information including waiting times at all providers to help patients make the best possible choice for them.
‘Today’s announcement of a pilot to expand this type of model to some out-of-hospital services will give patients more control over the different types of care they need, with the aim of helping to improve waiting times and quality of care.’
Earlier today Pulse revealed GPs’ worries around NHS England’s plans to replace the traditional system of direct GP referrals, with ICBs now being encouraged to take up an enhanced form of A&G.
It shows how clueless and desperate the Tories are now. I doubt Labour is any better. Same old cycle. This country needs new and real change.
Choice is a false god. This dying Govt weaponises the word in attempts to destroy the publicly funded NHS. When my car’s broken down, I don’t want choice, I just want my local garage to fix it. I don’t care if the garage is red or blue…
There’s already choice. My patients can get their hearing tested in any one of 7 local centres – but not one of those 7 centres can refer them on to ENT if needed.
There is no joined up thinking here, just more of the same old “patients want….” agenda without once stopping to try and make things actually bloody work. (And actually what patients want is the same thing we all want – good quality local care in a reasonable time frame with systems that communicate).
They’ll do almost anything other than properly funding and expanding the core services
Concepts such as “choice” and non-evidence based ideas like the “GPIP” are delivered instead of real services we actually need as a population
It’s pathological
So you now have a choice of a local long queue or a more distant long queue. A bit Hobson’s like to me.
David Jarvis is correct.
When the waits for (e.g. endoscopy) are 1 year in many years, what is the point of choosing another location where the wait is equally long?
To exercise choice there needs to be spare capacity – and there isn’t any. This is utterly pointless.
“Choice Change and people’s priorities” are the very worst of modern politics and leadership and are a form of gaslighting powered by polarisation post-truth populism and more often than not 3 word slogans
Sorry to say the great British public has been too stupid for too long to challenge and tories have exploited this
Having a choice of 10 sub-standard options, or having 1 clear option that provides a good service? Not a tricky decision really, so I choose to have a better (ie properly funded) service available within reasonable range. That’s OK Victoria, you can have my opinion gratis.
The only fucking choice I want is one involving a ballot box, and I want it now.
Usual nonsense. Jobs for the boys isn’t it?
Usual nonsense. Jobs for the boys intit?
More prolonged consultations, culminating in “doctor, which one should I choose?”
“You can choose from 5 different hospitals. They’re all crap.”
“Which mental health trust would you like to reject your referral?”