Letter: How much thought has gone into patient choice?

Dear Editor

Has it really been thought through fully?

Anyone would think, through all the media and DoH hype, that patient choice is a brand new concept. All you GPs out there - hands up if you have been giving patients choice of hospitals for years. Of course you have.

But this new patient choice idea has a twist in the tail - it is tied into contracts for services negotiated on our behalf between the PCT and the service provider.

So, a PCT and a hospital get together and negotiate a contract. Say, a 25 per cent discount (a good price), but the sting in the tail is that you only get the discount if you actually send 'x' number of patients to the hospital in a specified time period. So what, you may ask; how does it affect the way I work?

Well, you start getting snotty letters from the PCT trying to twist your arm to persuade patients to go to that hospital (rather that the one he actually wants to go to).

That's what. But wait a minute; you have to allow the patient to choose, don't you?

You can't deny him the hospital of his choice, so how are you going to work it to make sure that you get the fat, juicy 25 per cent discount?

Which also ties in the pretend budget of practice-based commissioning - but that's a different story - don't get me started.

Answers on a postcard please to Ms Patricia Hewitt MP.

So, your patients (at least from experience, the majority) want to go to the nearest (which happens to be a flagship outfit anyway).

I mean, if She-Who-Must-Be-Obeyed has to go into hospital for major surgery, I am not going to choose one 200 miles away.

Driving that distance for an evening visit with the kids in tow is just not an option. So I plump for the goody on my doorstep. But wait a minute - there is a shortage of slots in the clinic there. Why? Because adjacent PCTs have negotiated large chunks of the hospital services at bargain prices, leaving fewer slots for the locals. Sod it. So it's down to travelling further afield.

So, who picks up the transport bill? Answers on a postcard please to Patricia Hewitt MP.

But who catches the flak from patients for not having slots available at the hospital of their choice? Who do you think - it certainly won't be the PCT or their contract team.

Choose and Book is a nifty idea, placing secretarial duties right where they belong - in the lap of the GP. No, the GP sits there discussing the pros and cons of the various hospitals, while a waiting room full of unwell people cook and fume waiting for their turn.

So, the great, unwashed British public have been brainwashed into believing that they drive the NHS now. The minister has told them so. A massive amount of reform has been promised, but now they are expecting immediate delivery. If the DoH and the minister are to be believed, the majority of the population demand the choice afforded by these recent initiatives.

I would like to see all the paperwork produced by the survey that so readily convinced the government that reforms were needed.

We're busting a gut here at the coal face trying to make all of this work, so I would hate to see this whole thing melt down before our eyes, because if it could be made to work it could streamline things for the patient.

But I am very afraid when I remember all of the national computer systems that have fallen flat on their faces.

Has it really been thought through?

Once again, answers on a postcard please to Ms Patricia Hewitt MP.

John Ritchie, Practice Manager, Cambridgeshire.

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