Dr Phil Hammond, GP and broadcaster

Where do you stand on patient choice? To me, at least in theory, it sounds like a good thing. Patients should be able to make informed choices based on the best available evidence presented to them in an unbiased way. But try doing that in six and a half minutes.

The fact that compliance rates for any long term medication rarely nudge 50% suggests that half our patients choose to ignore our expert advice. We could accuse them of being misinformed but they may just be experts in their own risk management, happy to accept an increased chance of suffering something nasty in return for not taking the tablets. In which case, they should say so up front and not take the prescription.

This game of not taking the tablets and hoping we won’t find out doesn’t bode well for the honest, open doctor-patient relationship the Government hopes will save the NHS. Indeed, they’re putting a lot of faith in patient choice. A lot of our money is going into the new Commission for Patient and Public Involvement in Health, and statutory ‘involvement forums’ are about to be introduced into every hospital.

But primary care is where patients first enter the ‘choice pathway’ and to help them we may soon have a patient care adviser (PCA) in every primary care trust.

Like many things in the NHS, this development is based as much on political as moral grounds. New Labour have decided that provided the NHS purchases your care, free at the point of delivery, the provider can be anyone. So you can choose to have your hip done at your local NHS hospital, in a new private diagnostic and treatment centre, at a private hospital with an NHS contract, or in France.

Many people believe creaming off £2 billion worth of lucrative cold surgery and handing it to the private sector will destabilise the NHS. Not only will it lose money, but staff will be poached to work in private centres and the NHS will be left as a sink treating the critically and chronically sick, and anyone else the private sector can’t make money out of.

On the up side, forcing private hospitals to lower their prices drastically and fill their beds with NHS patients could well be the death of private practice. Why pay through the nose for a private hip replacement when you can go to the same hospital as quickly on the NHS? But never mind the ethics, will it work in practice? How will patients make informed choices between a myriad of new providers?

That’s where the PCAs come in. One expert described PCAs to me as travel agents. The GP and the patient get together and decide what sort of holiday is needed, and the PCA helps you decide where to go for it.

The Government, you’ll recall, is into travel analogies. Blair’s vision of the electronic booking system was for patients to book their own appointment with the GP from their home computer, just as they’d book a seat on a train or plane. GPs can then book direct into the consultant’s outpatient clinics – a real shift in the power base that will cause no end of ill-feeling.

But how will these PCAs work in practice? Well, apparently patients will be given all the performance indicators about the prospective providers, and the PCA (with no statistical training) will guide them through it. And guess who’ll get the call to answer the really tricky questions? You.

My guess is that, at the end of the day, patients will still opt for the nearest hospital with the easiest parking, which is about as much informed choice as most of us can manage when we’re ill.

Guidelines in Practice, December 2003, Volume 6(12)
© 2003 MGP Ltd
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