Patient choice

Patient choice is a concept introduced into the NHS in England. Most patients are supposed to be able to choose the clinician whom they want to provide them with healthcare and that money to pay for the service should follow their choice. Before the advent of the internal market, in principle, a GP could refer a patient to any specialist in the UK. When contracts were introduced in 1990 these were called extracontractual referrals. From 1999 the concept of Out of Area Treatments was developed. These referrals were not necessarily related to choice made by a patient. Specialised treatments were not, and are not, available in every area. Patient choice is a concept introduced into the NHS in England. Most patients are supposed to be able to choose the clinician whom they want to provide them with healthcare and that money to pay for the service should follow their choice. Before the advent of the internal market, in principle, a GP could refer a patient to any specialist in the UK. When contracts were introduced in 1990 these were called extracontractual referrals. From 1999 the concept of Out of Area Treatments was developed. These referrals were not necessarily related to choice made by a patient. Specialised treatments were not, and are not, available in every area. The regulations provide that a patient can choose to be seen by any NHS trust, public body, commercial organisation or third sector body, provided it holds a “commissioning contract” either with NHS England or a Clinical Commissioning Group when they are referred by their GP, community dentist or optometrist for treatment that is not identified as being immediately required. The Government’s mandate to NHS England for 2016-17 issued by Jeremy Hunt specifies “We want people to be empowered to shape and manage their own health and care and make meaningful choices, particularly for maternity services, people with long term conditions and end-of-life care”. Around 80% patients referred by their GP to a first outpatient hospital appointment were eligible to choose the hospital. There are however some exceptions to hospital choice policy. These exceptions include those where speed of access is important such as suspected cancer 2 week wait referrals and urgent referrals such as suspected stroke and heart attack. Referrals to mental health and maternity services were excluded from the policy until April 2014. Patients who are detained, and serving members of the armed forces are not entitled to exercise choice. The NHS Constitution includes a right to choice. It states: You have the right to make choices about your NHS care and to information to support these choices. The options available to you will develop over time and depend on your individual needs. It also repeats the requirements specified in the GP contract: You have the right to choose your GP practice, and to be accepted by that practice unless there are reasonable grounds to refuse, in which case you will be informed of those reasons. You have the right to express a preference for using a particular doctor within your GP practice, and for the practice to try to comply.