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Item Open Access A local view of factors influencing patient choice(2004-11-18T00:00:00Z) Isroliwala, Sabena; Wainwright, Charles E. R.; Sehdev, KamalThis report aims to deliver a local view on factors likely to influence Patient Choice. The findings represent coverage in selected parts of the Bedfordshire and the immediate surrounding counties. There were 22 GP practices and 29 GPs interviewed using quantitative and qualitative research methods. In addition, 11 patients falling under Bedfordshire and Heartlands PCT completed a questionnaire enabling a like-for-like comparison against the completed GP surveys. Variations existed in the quantitative findings between GP and patient expectations, with a pragmatic approach taken by GPs, believing waiting times and locality would be the key driving forces influencing Patient Choice of provider for elective surgery. In contrast, patients considered reputation or expertise to be far more important along with a clean and comfortable environment. Interviews with GPs highlighted further key points: • 78% of GPs refer 90% or more patients to the local hospital in the same county. The main reasons attributed to this is local hospital/close proximity followed by offering specialty and PCT contract. • If provided with greater choice, 68% of GPs said they were happy with the existing providers and would continue supporting local services. When probed on what criteria will be used to choose between future providers, reputation/specialty was the most commonly mentioned factor at 32% followed by local services at 29% and waiting list at 19%. Moreover, supporting comments demonstrated; i) A reluctance to use alternative trusts for specialties when little information existed. A few GPs commented on the relationship which had been established over many years and would be difficult to replicate under Patient Choice. ii) Many patients were perceived to be inadequate at making sense of such data on specialties and consultants; it was commented that disseminating such data would lead to confusion, incorrect decision making and ultimately a waste of time with the end approval returning to GPs. • The results of GP authority on patients was reaffirmed with many considering the desired empowering effect of giving choice to patients will fail to materialise. Just under half the GPs surveyed said Patient Choice will have no impact with under a third stating it will have a negative impact on patients. There was a consensus amongst GPs and patients alike on the potential influencing power of GPs on Patient Choice. However, the patient results revealed that hospital performance report, reputation of hospital/media reports and recommendation of GP or other health professional were of equal importance, ranking at third place. This may due to a biased sample coming from an Expert Patient group. Impact on GPs was assessed with 57% of practices believing Patient Choice will have negative repercussions with the booking system seen as extra work, taking time away from the allotted 10 minute consultation and once again returning to not knowing who the patient is being referred too. Overall, marketing in the NHS was seen as a good idea providing it served an informative purpose. It was interesting to observe the initial responses being negative followed by conditional positives. The idea around marketing serving to disseminate knowledge were supported with suggestions such as providing information on trusts, specialist units and consultants along with information on spare capacity and waiting times. Only 5% of practices surveyed said that marketing material would have a negative effect. The majority, 57% commented it would have a positive effect by raising awareness. GPs are happy to use local services with comparably short waiting times where good specialties are offered. If a trust has these offerings now and is able to continue with these offerings once Patient Choice has been launched in December 2005, minimal changes can be expItem Open Access PCT commissioning under patient choice: implications for Bedford Hospital(Cranfield University, 2004-11-18T13:06:19Z) Lang, Susan; Wainwright, Charles E. R.; Sehdev, KamalPrimary Care Trusts (PCTs) are responsible for commissioning secondary care for their local population, thus when patient choice comes into effect in December 2005 they will play a key role in choice by defining the four or five providers offered to GPs and patients for elective surgery. A broader overview on commissioning can be found in Cranfield University's report 'A Review of Patient Choice in the NHS' but the purpose of this document is to explain changes to the commissioning process under choice and the effect these might have on trusts. The Healthcare Management Research Group of Cranfield Postgraduate Medical School has been working with Bedford Hospital NHS Trust to evaluate the possible implications of patient choice. During February and March 2004 a number of meetings were held with key NHS stakeholders, including Strategic Health Authorities (SHAs), Primary Care Trusts (PCTs) and General Practitioners (GPs) in Bedfordshire, Hertfordshire, Cambridgeshire, Huntingdonshire and Northamptonshire, and also the Department of Health in London. Conclusions from these interviews were supported by a literature review of academic papers, news articles, books, government guidelines and patient surveys. In particular, the process by which PCTs commission secondary care providers is assessed and the nine pilot schemes were evaluated. Department of Health guidelines have only been issued for choice at six months so most PCTs are concentrating on meeting the six month target and have not yet formulated a plan for choice at referral. A dominant theme that emerged was therefore one of uncertainty, hence PCTs' predictions for how they will run choice form the basis of this paper rather than definitive policies.