PCT policy gives patients Hobson's choice

The DoH may have been criticised last week for having too many initiatives but no clear prioritisation or implementation strategy, but we are all clear on the overriding vision behind this chaos - patient choice.

Delivering choice regardless of whether it is needed or wanted would appear to be the one clear tenet of New Labour health policy (at least under Tony Blair). Thus it it is particularly shocking to find a flagrant example of restricting patient choice in the very forge of New Labour thought, Islington in London.

Islington PCT has openly declared war on small practices by stating it has a 'general policy of not replacing single-handed practices'. The issue came to light after the sudden death of Dr Mrigendra Nandi, a single-hander in the Finsbury Park area. Islington PCT made no attempt to replace Dr Nandi and instead allocated his patients to other practices. This has resulted in two of Dr Nandi's patients challenging the PCT in the High Court on the grounds they were not consulted before the PCT made its decision.

So much for choice.

Although patients appear to have liked Dr Nandi's service, the PCT has closed the practice because 'small practices do not meet the required national standards and targets' and many have premises that do not 'meet the requirements of the Disability Discrimination Act' (DDA).

If these practices are really not meeting standards then the PCT would hardly have to wait for death or retirement to close them down. Either there would be a patient safety issue requiring action or practices would cease to be viable because they would lose quality points and patients, and therefore income. As for the DDA, PCTs have been known to interpret this particularly tightly to try to force practices into super-surgeries.

In other words, the PCT stance is an excuse to push GPs into delivering services in a particular fashion whether or not that is suitable for local patients. If the government really backs patient choice, then it must back all choice and allow patients some say in how and where their GP services are delivered.

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