Rammya Mathew: More choice of providers won’t necessarily lead to better patient outcomes

General practices in my area have recently been on the receiving end of direct advertising from a wide range of private providers. The offer of having my patients seen by a specialist within 48 hours at no extra cost to them has certainly piqued my interest, particularly as NHS waiting lists aren’t improving in a hurry.

This tirade of unsolicited advertising seems to be a direct consequence of the new NHS Choice Framework,1 launched towards the end of last year. The framework is part of wider reforms intended to give patients more choice over where they’re treated and by whom. It gives them the choice to be referred to any healthcare provider that has a contract with the NHS anywhere in England for consultant led services.

Private providers have clocked this as an opportunity to increase their market share of NHS funded care and in turn grow their profits. They’re vying to get themselves noticed by GPs whom they see as holding the power when it comes to “supporting” patient choice. It’s a fair assumption, as my own experience is that patients ask me either where they can be seen most quickly or where I think they’ll get the best care. It’s actually quite rare for my patients to come with strong views about where they want to be seen—although this may be influenced somewhat by local demographics and my practising in a borough with relatively high levels of deprivation.

As GPs we have visibility of the waiting time to the first appointment for most outpatient clinics. But even for professionals immersed in the system, it’s almost impossible to objectively say which hospital or department offers the best care, especially as there are now vastly more options to choose from. What hope do patients have of making an informed decision that goes beyond wanting to be seen quickly?

If waiting times become the determining factor in deciding where to be seen, do mainstream NHS providers stand a fair chance of being able to compete? They deal with greater levels of complexity and have to balance the provision of elective care with the colossal demand for urgent and emergency care—all while training the next generation of healthcare workers. I worry that this kind of competition, rather than driving innovation, could seriously destabilise NHS providers, deplete an already paltry workforce, and further fragment services.

So, although greater choice seems like a positive move in the short term, without objective metrics to guide that choice I’m not convinced that we’re giving true power to our patients. I’m also not sure that the longer term ramifications of this initiative are in the best interests of patients who want a guarantee of excellent care—not only for straightforward problems that can be dealt with in standalone elective settings but also if they have comorbidities, require more complex interventions, or find themselves needing acute hospital care.