Choice without C&B

Linda Davidson

It’s D-Day for Patient Choice; the first time in the NHS’s history that GPs have been expected to offer all patients being referred for elective treatment a choice of at least four providers.

But at a briefing, ministers made it clear that that the Patient Choice initiative was no longer coupled to the Choose and Book programme which aims to convert the majority of GPs’ current phone, fax and paper bookings into a 21st century electronic process.

Health minister, Lord Warner, said: "I’d emphasise that you don’t need Choose and Book to give 100% coverage for choice to be exercised from January."

He said it would have been nice if the new system had been ready, but pointed out that by early December Choose and Book bookings were running at 6,000 per day and that nearly 25% of GP practices had gone live with the system and made at least one booking.

Officials confirmed that Choose and Book, which failed spectacularly to reach its October target of 50% electronic bookings, was "taking some time but it will happen." They quoted the estimated delivery time of "about a year" that NHS chief executive, Sir Nigel Crisp, gave to a recent hearing of the Commons Public Accounts Committee.

However the bookings are made, the launch of Patient Choice is set to have a significant impact on the NHS.

Health secretary, Patricia Hewitt is adamant that choice is the lever that will give patients access to the care they want and that critics who say, "People just want good local hospitals delivering good quality, fast, safe care," can be assured that choice will offer a better chance of receiving that care.

"Hospitals will become much more responsive to what really matters to patients; quality and speed of treatment, quality of food and the dignity and respect with which they are treated," she said.

She admits the possibility that waiting lists may build at the most popular hospitals but points out that the London choice pilot, which offered patients an alternative hospital if they had been waiting for more than six months, actually made the waiting lists fall.

Payment by Results also meant that successful hospitals could extend their services, she said.

Pressure on popular hospitals will be mitigated by a rule which prevent patients automatically joining waiting lists over three months long. They will have to actively decide to go on a three month plus waiting list and reject other options.

A question still hangs over whether some GPs will co-operate with the new system. National director for patients and the public, Harry Cayton, also chair of the Care Records Development Board, is confident patients will start asking questions if their practice is not offering choice when others are. He sees the patient as the new “third person” joining the GP and the consultant in influencing the referral.