Government turns up the heat on patient power

Tags: BMA Cancer Choice feedback GP NHS Choices Quality Vision

10 Mar 2009

The government has set out its vision for the future shape of public services, which includes giving patients greater choice and control over their care and more opportunities to input their own experiences.

In a white paper published today, Working Together- Public Services On Your Side , the prime minister Gordon Brown says he aims to put power in the hands of those who use public services, with more personalised services and greater choice, underpinned by an information revolution.

On health and health care the white paper highlights progress on a range of existing initiatives such as progress on the 18 week referral to treatment target, the setting up of 115 NHS Foundation trusts and the take-up of extended access by GPs, now offered by more than 70% of practices.

It says 25 new NHS Foundation Trusts could be set up in 2009, subject to Monitor approval, giving hospitals more control over day to day management and says the nurse-led productive ward programme, which aims to free nurses from bureaucracy, will also spread rapidly across trusts and wards in 2009.

NHS Choices will be expanded to enable patients to comment on the services offered by GP practices and the amount of hospital payments linked to Patient Reported Outcome Measures (PROMs) will be increased year-on-year.

The white paper also announces that the government will set up a commission on the future of nursing and midwifery and says standards such as the two week cancer standard for cancer patients and the 18 week RTT target must become the guarantors of high quality care for all.

This summer NHS Choices will be developed to enable patients to give direct feedback on all GP surgeries, extending the existing service which allows patients to log comments about their hospital. The white paper says around 10,000 comments have been posted since NHS Choices was launched in 2007.

In his foreword to the white paper Gordon Brown said the government had been much too slow to make use of the “democratising power of information”.

He added: “People take it for granted that they will access other people’s reviews and ratings before buying something on e-bay or Amazon, and yet we do not yet have systematic access to other people’s experiences when choosing a GP practice or nursery. We have clearly got the balance wrong when online businesses have higher standards of transparency than the public services we pay for and support.”

However, the BMA said that although doctors welcomed feedback on their services it was concerned about the government’s proposals.

Dr Hamish Meldrum, BMA Council chairman, said: “The consumerist approach being advocated by the government is not well-suited to the NHS. Patients are not supermarket customers, and doctors are doing more than providing an easily rated commodity.

“Healthcare is complex – it’s about partnership. The suggestion that your treatment in the NHS can be as easily rated as a stay in a hotel is simplistic. There is a risk that this exercise could reduce NHS care to a meaningless popularity contest, encouraging perverse behaviours and an emphasis on the superficial.”

On PROMs, which will be used for hip replacements, hernia surgery and varicose vein surgery from April , the white paper says the quantity of the payment linked to outcomes will increase year-on-year as quality measurement improves and commissioners focus on ever higher outcomes.

The white paper highlights patients’ rights as enshrined in the NHS Constitution, including patients’ right to make choices about NHS care.

In an interview with the Sunday Telegraph at the weekend health minister Ben Bradshaw indicated that the renewed emphasis on choice could see GPs’ contracts terminated if they did not offer a choice of hospitals to patients who need specialist care. Latest Department of Health choice survey figures show less than half of patients (46%) remembered being offered a choice of hospital for their first outpatient appointment.

This week a Department of Health spokesperson told EHI Primary Care: “Patient choice is about to be made a legal right through the NHS Constitution. It is no longer acceptable for patients in some areas to be less likely to be offered a choice, than in others. We expect all PCTs to make sure that patients are aware of their right to choose and have the necessary support and information to do so.

"We are considering how we might further ensure that GPs make offering choice a priority. We are in the early stages of exploring a range of options, including whether we could reinforce this through the GP contract. Once we have done so, we will be discussing this with the profession."

The white paper says developments in technology are enabling more treatments to be delivered outside healthcare environments at similar cost to providing the care in a clinical setting. It adds: “Increasingly services as varied as maternity and cancer care will be offered to patients in their homes, at their convenience.”

The white paper also underlines the pledge to provide personal care plans to 15m patients withlong term conditions by 2010, as well as the plan to offer avascular health check to all patients aged between 40 and 74.

Fiona Barr

Reader's Comments

Looking at the whole white paper...

10 Mar 09 21:03

Don't you love the sweeping assumptions - and, I suspect, factual inaccuracies?

For example, how competent is Jobseekers Plus to deal with their current obligations - let alone have the competence to deal with complex assessments?

I am aware of a case where the maternity benefit - no question about the entitlement - was paid six weeks after delivery. The extremely competent young woman concerned was told "we have so many people calling to complain that we have decided to take the phone off the hook!" Fortunately she had support - otherwise she might have been evicted from her accomodation - **all because her calculations included the assumption that the Jobcentre Plus concerned was capable of processing claims.** A mistake.

I feel the same applies to most of this white paper.

Including health.

When will GB get a reality check?

Asking the right questions?

11 Mar 09 09:03

'Latest Department of Health choice survey figures show less than half of patients (46%) remembered being offered a choice of hospital for their first outpatient appointment.'

And did anyone think to ask whether these patients were at all bothered by this? Is it only me that thinks there's some irony that in all the high blown rhetoric about patient involvement and patient choice, nobody seems to have asked patients whether they actually want the kind of choice that's being forced on them?

i'm a patient

11 Mar 09 10:03

and i want a choice of where and more particularly when i get treatment. I also want to know if my consultant in competent to do the job. If you dont care, thats your look out

I'm a GP

11 Mar 09 11:03

That offers choice. I sit with the patient and take them through the options on Choose and Book.

Today I have made two referrals. The first was for dermatology in a child. Every service listed within 40 miles (and that was around 20 different hospitals) had no appointments available. The mother eventually 'chose' to go to a hospital that will require a 90 mile round trip but left very unhappy. Will she remember being given a choice? I doubt it.

The second referral was for a suspected cancer. The speciality concerned has only one centre to which I'm allowed to refer. Will that patient say they had a choice? No

I look forward to having my contract withdrawn for 0% patient-perceived choice today.

I'm a GP too

12 Mar 09 12:03

Remember when Patient Choice was confirmed by giving patients a questionnaire to fill in *at the time of referral* and leave at reception? (used to be in January - February IIRC). Not only was choice discussed, but it was rubbed in by the request to fill in a questionnaire - and we *still* didn't get 100% confirmation of being offered Choice! I'm not sure how valuable "Choice" is - or whether it should be used at all, ethically - when the only Choice is Hospital - not named Consultant. Take Orthopaedics. One referral from my practice went from Orthopaedics ( upper limb) -> neurology _> orthopaedic back surgeon -> orthopaedics (upper limb) - **requesting a new referral from GP every time with the comment - copied to the patient - "I don't know why your GP thought your problem lay in my area! you obviously should have been referred to x!"** All the letters went with every referral. Isn't Choice (as exemplified by C&B) a brilliant system - for PbR?

You're a GP

12 Mar 09 16:03

In the example you give the patient's mother had one further choice. Had she called the TAL to book the appointment she could have insisted on being seen by her choice of hospital who would then have been contacted by the TAL with a requirement to offer the patient a prompt appointment, and importantly the 18 week clock would have been started.

It's not a perfect solution but trusts will in time manage their capacity within choose and book better if the system is used. (Alternatively they'll keep not publishing any appointments and stop getting patients/paid!)

I'm a GP 2

13 Mar 09 08:03

The TAL approach sounds great--until you find that the first choice hospital has adopted an approach where it deals with all 'forced' bookings for dermatology by rejecting the referral.

RE: I'm a patient

13 Mar 09 21:03

'and i want a choice of where and more particularly when i get treatment. I also want to know if my consultant in competent to do the job. If you dont care, thats your look out'

This posting rather illustrates my point. I agree that most patients want more flexibility from the NHS and things like a 'modern' national electronic booking system. But what else? You want to shop around for a competent consultant? Shouldn't they all be at least competent, otherwise they shouldn't be practicing at all. And do we really want some kind of reality TV style popularity contest as a proxy for competence? After all, a lot of Harold Shipman's patients would probably have said that he was a competent GP.

These are complex issues, and there is little real evidence that the general public has much appetite to shop around for healthcare, let alone the necessary skills to tease out the meaning from the information available. So what 'choice' are they really being offered? And how exactly is this supposed to drive up quality in the NHS? I can't find an answer in the garbage that passes for DH policy.

GP services /choose and stay put!

shurleea@btinternet.com

17 Mar 09 20:03

My GP Dr Paul Chisnell based at Valkyrie Road Westcliff on Sea ia fantastic, he really cares, the practice is a traditonal 'family'practice where every patient is treated as the most important person during each consultation.

Our surgery may not be the most modern with fancy gizmos all ove the place but the care is second to none.

I really do feel cared for, at one time during some very difficult times I went to the surgery and My GP had locke dup to go home, nothing was too much trouble, he opened up and gave me his time, a time that rightfully belonged to his own family, but he is very caring.

No matter how many fance new surgeries open up, this si the qulaity of care Iwant and need and if I had to go to a plush new surgery and 'pampered' by a string of doctors, or sit in the car park in the rain and been seen by Dr Chisnell, I wouldn't hesistate to choose the latter.

We have lost he 'family doctor' service to foreign money, expensive leased builidngs adn without any doubt, then end is nigh, once these places a rewell established and codcotrs forced to comply, the NHS as we nwo it will fade into our distant memories. This is privatatisation of the NHDS by strlth and we all need to wae up to this reality.

Choose and Book ... nothing but hastle, I choose to stay with my own GP not pay a private company to tell my GP what he already knows!

Please allow us the right to keep our own family doctors!

Re:GP services /choose and stay put!

19 Mar 09 10:03

First it is very heartening to hear you are so pleased with your GP, he does sound like an excellent clinician.

However, I would like to pick you up on a couple of the later points you make:

You critisize modern leased buildings. There are many benefits to setting up a practice in a modern building. They are often easier to keep clean and hygenic for the patients. Access for disabled patients is possible (often not the case in the victorian terrace style converted house practices) and provide more space for the doctor to work in.

I would hazard a guess that if offered Dr Chisnell would prefer to work from such premises (and would no doubt still offer such good care)

You would prefer to stay with your GP than be referred using Choose and Book. Choose and Book is a service for referring patients for hospital appointments. No matter how good your GP is surely if you needed a hip replacement or heart bypass you would prefer to have it in a hospital!

Choose and Book provides a quick and efficient method of making that referral (incidentally I thought a lot of my GP before upon referring my to hospital she FORGOT to post the letter, a mistake which did not come to light for 10 weeks and would not be possible had she used Choose and Book.