Learning from practice

Patient choice and its effect on five specialist HIV units in London


In one specialist area, the right of a patient to choose where to be treated was routine, and a payment system evolved that does appear to have added some incentives to providers based on the choices made by those patients. This case is the care and treatment of people with the human immunodeficiency virus (HIV).


From the mid-1980s to the mid-1990s, specialist units were created within hospital trusts to treat people with HIV. Care of patients with HIV/AIDS evolved in the specialty of genitourinary medicine, which had a tradition of ‘open access’ and confidentiality dating back to the 1920s (Berridge 1996). From the first appearance of the virus in the United Kingdom, people with HIV had the right to refer themselves to any HIV unit of their choice and could leave whenever they chose, to go to another unit, or even choose not to be treated.


 A funding system evolved to respond to this unusually high degree of patient choice, which rewarded providers on the basis of the numbers of patients they treated.

Because the bulk of HIV/AIDS cases was (and still is) in London, many of the specialist units were built in London, allowing many patients a range of units to choose from.



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Source: desk research for NHS Institute by Matrix research and consultancy