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Patient choice in the NHS not working

The King’s Fund

A new report published today by The King’s Fund shows that having a choice of hospitals is in theory valued by the majority of patients, in practice it has little effect, as the system is not operating properly.


Since April 2008, patients in England have been able to choose treatment from any hospital in a national directory. The new report assesses how patient choice is operating based on research with patients, GPs and hospital providers. The research suggests:


  • While 75 % want to choose where they are treated, only half recall being offered a choice by their GPs

  • Only 8% of those offered a choice recalled being offered the option of choosing a private provider

  • Most remain loyal to their local hospital and choose to be treated there

  • Previously having a bad experience of their local hospital is a major reason why patients choose to access care from an alternative provider

  • Hardly any use performance data to help choose

  • GPs are offering choice as they must, but rarely fully discuss options available


Choice is not improving quality or increasing competition. The main focus of competitive activity among providers is securing GP referrals rather than directly competing for patients, and this occurs only at the boundaries of their catchment areas.


Anna Dixon of The King’s Fund says, “Patients clearly value choice, even if in most cases they prefer to stay with their local provider. 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.”



It suggests that while everyone is going through the motions of patient choice, the time and money spent on comparison statistics and choice is seen as mostly irrelevant by patients.


Private medical insurance: News update: 7 June 2010


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