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The challenges of choice


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Saturday, 25 September 2010

The challenges of choice

On the face of it, the proposed abolition of practice boundaries is another victory for patients in a world addicted to choice.

Most people -- 95% in a recent survey* -- think they should be able to choose their GP. Almost as many (80%) support the abolition of practice boundaries. It seems clear that many people assume the former is a product of the latter.

The removal of practice boundaries would give more choice to the patient, who would in future be able to register with a practice where it is most convenient - near work, for example - or where a better service is available. If you don't like your brand of GP, switch to a better one.

The problem with this idea is that choice only works if it is well informed. But only 30% agreed with the proposition 'I have all the information I need to make an educated choice about the right practice for me', suggesting that while most people love the idea of choice, today only a minority would know what to do with it.

Nearly two-thirds disagreed with the proposition that 'GPs are the best people to decide how and where patients are treated', reflecting the belief that decision making should be shared with the patient and with other professionals where appropriate.

A majority of respondents (60%) would 'trust GPs to commission other healthcare services on my behalf'. We can safely assume that the remaining 40% would go along with the proposition if they were consulted.

We might reasonably summarise the results as follows: increasing choice by removing practice boundaries will also increase the chance of seeing a GP who will do the right thing for the patient - but only as long as patients have the information to make educated choices and a voice in the decision-making process.

The white paper has identified the practice list as the logical denominator of commissioning. For GPs to be effective commissioners depends on knowing the patient and understanding the context - where patients live and what local factors may influence their health needs. More choice of GP and potentially more fragmented lists may make commissioning more challenging.

* All figures from a straw poll by NHS Networks of delegates to a consultation event on practice boundaries held in London at the end of June this year.