We have been reflecting on the outcomes of our recently concluded formal investigation into a complaint that alleged patient choice was not operating effectively in elective care.
The right to choice means that patients have more control over their care. They can select providers based on what is important to them and can travel out of their area for elective care if they choose to do so. And providers have an incentive to offer the best care possible so that patients will choose their services over other providers.
What commissioners should be doing to let patients know about available elective services
When a patient requires an elective referral for a first outpatient appointment with a consultant or a member of a consultant’s team, he or she must be given a choice of any clinically appropriate provider that has a contract with any commissioning body.
As commissioners, you have an obligation to ensure that patients are given this choice. In practice, this means you need to have a fair and transparent way of selecting which providers patients can choose from.
There are some basic principles that govern how this should work:
Set criteria for providers to qualify to provide services
You don't need to run a competitive tender or consider running a competitive tender process for consultant-led elective care. Instead, you can assess new providers against the criteria used to establish existing providers as suitable.
These are usually that a provider is:
- registered with the Care Quality Commission (CQC)
- willing to provide services at tariff under an NHS Standard contract
- able to demonstrate competence to provide a high quality service.
All providers seeking to offer services should be treated and assessed equally.
Offer patients a choice of any provider
The easiest way to offer the choice of any provider that has a contract with any clinical commissioning group (CCG) is through Choose and Book (e-Referral in the future).
You should also ensure that any elective care providers that you contracted with are offered nationally through Choose and Book. This allows patients in neighbouring or other outside areas to choose those providers.
Be prepared to pay for services on a non-contractual basis
When patients choose providers not under contract with the CCG, NHS England has guidance on how this payment mechanism should work (PDF).
Where a significant number of patients are selecting a non-contracted provider, you should consider joining the lead CCG’s contract or entering your own.
Give patients adequate information about the choices available and support to make decisions
Referral management operators, for example, should be well-trained to explain the right to choose and provide information about things like waiting times or distances from home so that patients can make an informed choice.
As well as being given information about Choose and Book, patients should be supported to use it.
Focus on what meets patients' needs
Some commissioners have expressed uneasiness about opening up patient choice to new providers or providers from outside their local area. For example, one commissioning body was nervous about commissioning another elective care service in its area because it believed it might end up costing more overall or might destabilise other local providers.
Naturally, commissioners want to ensure that their local services continue to exist for patients in the future. But your focus should always be on what is best for your patients. The risk of destabilising a local acute or other provider is not a good reason to prevent patients from accessing other providers if they choose to do so. Rather than trying to control costs and demand by limiting capacity, ensure referral thresholds are set appropriately.
What are you doing to ensure patients are offered choice in your area? Find out what steps the two CCGs involved in our formal investigation are taking.
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