News Release: Report on Patient Choice in the UK

Thursday, 3 June 2010

Support for patient choice but it is not yet driving quality improvements, says new report

report published today by The King’s Fund shows that having a choice of hospitals is valued by the majority of patients. However, it is not yet operating as intended and has not so far acted as a lever to improve quality and increase competition.

Since April 2008, patients in England have been able to choose treatment from any hospital in a national directory. The new report Patient Choice: How patients choose and how providers respond - published jointly with the Picker Institute, RAND Europe and the Office of Health Economics - assesses how patient choice is operating based on research with patients, GPs and hospital providers. The research found that:

  • While 75 per cent of patients want to choose where they are treated, only around half recall being offered a choice by their GPs.
  • Only 8 per cent of those offered a choice recalled being offered the option of choosing a private provider.[i]
  • Most patients remain loyal to their local hospital (69% choose to be treated there).
  • Having a bad experience of their local hospital is a major reason why patients choose to access care from an alternative provider.
  • Few patients are making use of performance data to inform their choices - just 4 per cent of patients consulted the NHS Choices website - with most preferring to rely on their own experience or the advice of their GP.
  • GPs said they were offering choice routinely but this was rarely a meaningful discussion of the options available.

While GPs broadly supported the idea of patient choice, many who took part in the research underestimated its importance to patients, distrusted comparative performance data and felt unable to advise patients on referrals outside their local area. They also strongly criticised Choose and Book, the electronic system for booking appointments for treatment, which has been weighed down by technical problems since its inception.

The report shows that choice is not yet acting as a sufficiently strong lever to improve quality or increase competition, as the policy intended. The main focus of competitive activity among providers is securing GP referrals rather than directly competing for patients, and this really only occurs at the boundaries of their catchment areas. Interviews with providers revealed that in many cases they are choosing to cooperate rather than compete with each other.

The research also debunks commonly held assumptions that only certain groups are interested in patient choice. Patients living in non-urban areas were more likely to be offered a choice and more likely to choose to travel beyond their local provider than those in urban areas. Older patients, those from mixed or non-white backgrounds and those with no qualifications were more likely to think having a choice is important.

However, while there were no apparent inequities among those who were offered a choice, older, more educated patients were more likely to choose a non-local provider. This suggests a potential risk that, where local providers are providing poor quality services, some patients may be ‘left behind’ while others exercise their right to choose to be treated elsewhere.

Anna Dixon, Director of Policy at The King’s Fund and the report’s lead author, said:

‘Patients clearly value choice, even if in most cases they prefer to stay with their local provider. Choice does appear to be having an indirect effect on quality by motivating providers to maintain their reputation in order to avoid losing patients. But the reluctance to implement choice among GPs and little use of performance data by patients suggests there are still a number of significant challenges that need to be overcome if the policy is to be implemented as policy makers originally envisaged.

‘While it is still early days, 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.’


[i] Since April 2008, all patients referred by their GP for a non-urgent hospital appointment have had the choice to be treated at eligible private sector providers as well as NHS hospitals.  

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