Expansion of patient choice but what does it mean on the ground?

The Department of Health and Social Care’s announcement that patients will be able to benefit from a wider range of healthcare services, with its intention to roll out “the biggest expansion of choice in the NHS in a decade” follows the Prime Minister’s announcement in May 2023 to refresh its patient choice policy as part of its efforts to cut NHS waiting lists. Since then, we have seen a strengthening of the patient choice agenda with the establishment of the new Independent Patient Choice and Procurement Panel. Part of the panel’s remit is to advise on disputes about providers’ ability to obtain a contract to supply patient choice-based services in addition to the Provider Selection Regime disputes.

The Government and NHS England have also announced that it will be accepting the Chair of the Patient Choice and Procurement Panel, Andrew Taylor's, four recommendations to the NHS to reduce barriers to patient choice - including publishing more data on choice and appointment bookings.

The recommendations and their underlying rationale, as published are as follows:

1. NHS England to monitor and regularly publish data, by ICB and specialty, on the number of electronic Referral Service (eRS) appointments made available to NHS patients but not used. This would provide information for patients and GPs about services where patients may be able to access care more quickly. Also, identifying those regions where capacity is going unused could help prompt local-level discussions about whether there are local constraints on choice that could be addressed.

2. Referral Assessment Services (RASs), and other interface services, to publish data regularly on the number of onward referrals to each provider, by specialty. This information will let RASs demonstrate that onward referrals are not being channelled to providers. In doing so, it will build providers’ confidence in the patient choice system and help underpin further investment in treatment capacity.

3. RASs, and other interface services, to provide all local providers with access to their policies, procedures, information and systems used to manage onward referrals. These arrangements will let local providers understand how RASs manage onward referrals and help facilitate local discussions aimed at identifying improvements that could be made to further enable patient choice.

4. The Panel’s remit be expanded to include advising on all provider complaints about restrictions on patient choice (where such complaints cannot be promptly resolved by NHS England’s national choice team). This will strengthen existing mechanisms for addressing local constraints on patient choice by providing an independent oversight mechanism and will allow the Panel to consider representations from providers about all constraints on patient choice not just those related to provider accreditation.

So, what does the expansion of patient choice look like?

Under Government proposals, patients requiring routine treatment outside of hospitals will be able to choose between multiple providers across the NHS, the independent and charity sectors. Services which could be within scope for the pilots include:

• Hearing aid care
• Endoscopy
• Dietetics and nutrition
• Ambulatory ECG heart activity
• Podiatry

We understand the patient choice expansion will be tested using pilot areas across the country starting in the autumn offering patients a choice of where they receive out of hospital care. This will mean that when a patient is referred to a piloted service - where clinically appropriate – they will be able to choose which provider is best for them. This might include the independent sector, but the treatment will always be free of charge and at NHS costs and standards. In a Department of Health and Social Care letter announcing the patient choice expansion pilots, it explains that NHS England will begin detailed engagement with a subset of Integrated Care Boards (ICBs) to discuss the potential for piloting introducing choice for certain pathways of care in a local area. NHS England’s work will also include identifying the barriers as well as quantifying the activity, financial and capacity impacts. 

As we know patients can already choose where they receive care when referred to an in-hospital consultant-led service. Following a consultation with their GP, patients should be offered information on a minimum of five providers, with information about waiting times, distance to travel and quality to help them make their choice.

This expansion builds on the Government's action to reduce waiting lists as we have seen with extra tests, checks and scans being delivered by the community diagnostic centre programme.