The announcement of an NHS patient’s right to choose their GP practice and a specific doctor will have repercussions for surgeries and PCTs, the chief executive of the NHS Confederation, Steve Barnett, has warned.
Mr Barnett’s comments came in response to the government’s announcement of the new NHS Constitution, which he should be seen as the start of a process of change, rather than the end.
“The constitution presents a framework for the NHS as it looks to become a world-class health system for the 21st century, and we should all be looking to surpass the standards it sets,” Mr Barnett said. “The ultimate test will be to prove that it makes a difference to the experience of all patients and staff.”
He added: “The Constitution’s inclusion of rights for members of the public to choose their GP practice and a specific doctor within that practice will be welcome news for patients. However, it will have repercussions for PCTs and doctors’ practices, and the appropriate funding and staff levels will need to be in place to ensure that this can be made to work.”
Mr Barnett also warned that the constitution may need to be more specific in certain areas, including rights to drugs and the environmental sustainability of the NHS.
Dr Hamish Meldrum, Chairman of Council at the British Medical Association (BMA), also welcomed the Constitution, yet said it needed to be about more than just a “feelgood” factor.
He said: “The patients who depend on the NHS and the staff who work in it have both long deserved a clearer idea of their rights and responsibilities. This is a welcome restatement of the principles of equality and compassion on which the health service is based.
“Yet we need more than a ‘feelgood’ document. In its current form, it is unclear how the Constitution will change the everyday experiences of patients and staff.”
Dr Meldrum advocated “concrete measures” such as the creation of a national independent board to oversee the day-to-day operation of the NHS, which he said would help “depoliticise” it.
He added: “There also needs to be much more engagement with the public and staff about the way services are delivered at a local level. The BMA will continue to push for progress on these issues.”
Will the right of patients to choose their GP be difficult to implement? Your comments (terms and conditions apply):
“I think it’s overdue. I have moved 1 mile and still in the same PCT area but my post code has altered so i’m told i have to move GPs which means i’ll be moving to a Dr’s that i don’t want to go to and their iffy about having me as i’m not in their PCT area!! Makes no sense to me ! The system needs to be looked at and changed SOON!” – Name and address withheld
“I would like to go back to my old doctors’ surgery that I had to leave due to relocation. I am quite willing to drive the 25 minutes it takes to get there, as I have no patient and doctor rapport with my current doctor” – Jill Chapman, St Leonards on Sea
“These comments have a strong bias towards what the GPs want. Surely the patient’s needs come first? I work 10 miles from my GP and it’s a right pain in the neck when I have to visit. I also need repeat prescriptions and these have to be all done by post with SAEs, which is another pain and expense I could do without. Add to all this the fact I don’t actually like the practice but it’s the only one in my area taking on patients. The sooner I can change GP the better as far as I’m concerned” – Simon Parker, Cambridge
“Will this soon happen as we have moved two miles from our practice area and want to stay after being with them 28 years” – Stanbrough Family, Hertfordshire
“Patients’ right to choose their GP will affect surgeries, says Confederation! Is this now in practice or not???” – Tom, Glasgow
“Yes, I was with a doctor’s surgery for 27 years, they moved three times – made no difference to me, but I moved a five-minute drive (20-minute walk) away and I was told to find another GP. I was with that surgery before those who got rid of me. In all those years they were called out to me twice” – Peter Youles, London
“It will certainly put more pressure on resources. Patient should have the right to choose their own doctor. If I am choosing my own builder or plumber then why not my own doctor? The PCT should look into why a practice or a particular doctor is more popular. Patient trust is the most important thing. If I think I could have a better doctor than what I have been allocated by a postcode system, confidence and trust do not develop. We should have the right to choose our own practice, why not?” – Mesbah Rahman, Cardiff
“What will happen to GPs in training? It’s difficult enough to get patients to see these doctors, no matter how well-qualified and good at their jobs they are. If these proposals are open to the interpretation that the patients only see their ‘chosen’ GP, then there will be no opportunity for the doctors in training to ever consult with patients except extreme acute cases who will agree to see any doctor. They will never get a fully rounded experience of general practice if they don’t get to deal with chronic and returning patients in meaningful numbers. Medical students might as well not bother even coming in!” – Eileen Hester, Fort William
“We employ six part-time salaried GPs (no partners) working a variety of sessions from 2–6. It will be almost impossible for us to meet this target; indeed we do not do so now. This will only raise patient expectations leading to frustration, disappointment and, ultimately, a breakdown in the patient/doctor relationship” – Name and address withheld
“We are a single-handed practice with a part-time GP; we already have patients registered who live outside our locality, we will keep them on when they move providing they have moved into an area covered by our out-of-hours consortium; having said that problems arise when they need maternity care, health visitors, district nursing etc, all of which are locality based. This causes problems for staff. If all patients can choose where they want to be registered, ie, at their place of work this problem would have to be addressed” – Anna Richardson, Essex
“If patients are really ill they will be grateful to see any doctor – this is a nonsense and another target, which is unneccessary and unachievable dependant on differing surgery circumstances” – Name and address withheld
“Again, another impractical idea. With more GPs working part-time, how can we fulfil patients’ expectations? When I am feeling unwell I am grateful to see anyone” – Name and address withheld
“It is unfortunate that the government uses this tactic to put pressure on GPs who are excellent at their jobs. Less popular doctors are not necessarily bad at their jobs but peer pressure may force them into improving their ‘bedside’ manner. It will be the job of managers to facilitate this (we get all the good jobs!)” – Name and address withheld
“Might make for interesting out-of-hours/visiting arrangements, not that this will have occurred to anyone who is not actually working in general practice” – Name and address withheld
“When you have part-time GPs who are popular it is most likely they will be difficult to see. This will be even more highlighted by the senior GPs who are moving towards retirement and reducing their commitment – the demand for them will not suddenly reduce. There are a number of practices in that position. If patients find it increasingly difficult to see the GP of their choice it will have a detrimental effect on any survey” – Kevin Bernard, Suffolk
“We need clarification. It won’t be particularly difficult to implement if a doctor can operate a waiting list, but if the GP has no control over the number of patients on his/her list then the suggestion is ludicrous” – Kate Harlow, Tunbridge Wells
“Yes it will. It is not so long ago since we started telling patients that we now have a ‘practice list’ – although of course in practice patients still choose who they prefer to see. It is completely impractical to expect us to be able to offer specific doctors and meet access targets – although of course we prefer patients to be able to see the doctor of their choice where possible” – Alison Field, Worcestershire
“We have one GP who EVERYONE would like to see – if we cannot address this it is going to make for huge stress levels for staff and the GP. It might even culminate in that GP leaving the service – obviously this has not been thought through – again!” – Name and address withheld
“No – they can choose who they like. What they choose and what we can deliver is a totally different question – a part-time GP cannot see a fulltime demand” – Justin Pearce, Northampton
“How will this move to choose a specific doctor, rather than a practice, affect access targets and patient survey results? I have part-time doctors with over 2,000 registered patients” – Alan Morton, Stockport
“The first thing that comes to mind which should be obvious is the demand on any specific doctor means that waiting times to see the doctor will be longer. When they say ‘choose any GP’, does this take into consideration the geographical location? ome of the patient choice issues that are being implemented in the NHS are not necessarily the best way forward, and it feels to me that whoever is making these decisions either is not researching enough or is not in touch with the service at ground level” – Dean Thompson, London
