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New research shows GPs hold the key to patient choice

2 September 2003

New research shows that while people want more say in their healthcare choices, they and their GPs are worried about the impact providing that choice will have on the workload of family doctors. MORI surveyed the general public and GPs ahead of the Bupa health debate at The Royal College of Physicians: "Can healthcare afford the informed consumer?". The research suggests that 88 per cent of doctors and almost half the British public (46%) worry that extending patient choice will put more pressure on GPs.

Another concern is indicated by three-quarters of the public who say they are already confused by the amount of conflicting health advice available. The same proportion look to their GP to guide them through this 'health maze'. Almost two in five (38%) feel that NHS patients currently do not have any choices, and a further 36% 'don't know' what choices they have.

The research suggests that as well as being concerned about the potential increase in workload, many family doctors do not believe that providing more choice will improve the standard of patient care. The expectations of the public, however, are very different. Almost half (46%) think choice will mean better care. There are other differences in understanding and expectations for patient choice between GPs and the general public. For example, GPs believe that 75 per cent of patients want to choose their surgeon but only 40 percent of the public say that they would want to be involved in this decision.

Despite some reservations the public and GPs alike want to see more choice for patients. Both support patients being able to choose in which hospital to have an operation or at least being more involved in this choice. GPs also want patients to have more information about their treatment.

A member of the Bupa health debate panel, GP and member of the Royal College of General Practitioners council, Theo Schofield, comments: "The ideal is that decisions about treatment should be shared between the patient and their doctor. To achieve this the doctor needs time to listen to the patients' perspective, information and evidence that is readily accessible, and the skill to tailor advice to the individual patient."

A contributor to the debate, Harry Cayton, director for patients and the public at the Department of Health, says: "Choice improves patient experience of the NHS by giving them real power to make decisions about their treatment and care. We are consulting patients and NHS staff and clinicians about how choice can be focused on what people really want and on how it can be extended to all."

Alan Maynard, another speaker at the debate and professor of health economics at York University, says: "We have to guard against the possibility that the 'expert patient' with the right information and an understanding of the system, monopolises GPs' time. Patient choice initiatives should not be at the expense of other goals of the nation's health system for example, efficiency and equity. If the system cannot respond to patients exercising their right to choice, then giving them further choice is pointless."

Andrew Vallance-Owen, Bupa's group medical director, concludes: "We share the Government's enthusiasm for greater choice but it has to be real choice, for example: giving patients greater involvement in decisions about their treatment. While a number of initiatives have been successfully piloted, there are further challenges to negotiate including the funding of individual healthcare choices. Choice is not just about where care is delivered but also how it is funded, for example: could the future of patient choice see individuals using their NHS entitlement alongside their own financial input to effect real choice?"

The Bupa health debate: 'Can healthcare afford the informed consumer?' took place on Tuesday 2 September 2003 at the Royal College of Physicians. The annual Bupa health debate was attended by 200 of the country's top medical professionals, health economists and policy makers.

The speakers are:

• Professor Robert Worcester, chairman, MORI
• Mr Harry Cayton, director for the patients and the public, Department of Health
• Dr Jennifer Dixon, director of health policy, King's Fund
• Professor Alan Maynard, professor of health economics, University of York
• Professor Richard Scase, professor of management, University of Kent

Summary statistics

Definitions of patient choice

• 44% of the general public were unable to say what 'patient choice' means.
• GPs are most likely to define patient choice as being able to choose medication or being involved in its choice (40%).
• Almost two in five (38%) of the general public feel that NHS patients currently do not have any choices, and a further 36% 'don't know' what choices they have.
• 81% of GPs feel that patients will welcome more choice over their treatment.

Consequences of extending patient choice

• 88% of GPs feel their workload will increase.
• 46% of the general public agree that their GPs workload will increase.
• 84% of GPs and 74% of the general public agree that even if patients had more choice, many of them would still find it difficult to express their healthcare preferences.

Health information

• 76% of the general public would use their GP as their first source for health information.
• 77% of people see their GP as the most trusted source of health information.
• 76% of people think there is so much conflicting health information available, they do not know what to believe.

Standard of care

• 48% of GPs feel that increased patient choice will not alter the standard of care patients receive.
• 28% of GPs believe that this standard will get worse.
• While 46% of the general public feel standards of care will improve.

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