Choice in outpatient services

Strengthening choice in outpatient services

The Choice Framework outlines nine areas of patient choice, some of which are supported by legal rights. The elective care choice programme is focussed on improving three in particular:

  • Choice of where to go for a patient’s first outpatient appointment, for both physical and mental health,
  • The right to ask to change hospital if a patient is likely to wait longer than the maximum waiting times,
  • Choice of who carries out specialist tests when referred by your GP.

The 2015 choice survey found that 47% of patients were aware of their legal right to choice and fewer than half (40%) of outpatients recalled being offered choice. This indicates that more needs to be done to embed choice in elective services, although there is recognition that there are many challenges.

Barriers and enablers

There are a number of enablers that need to be in place for patient choice to work well in any given area or locality. These enablers have been categorised into three broad groups:

  • Infrastructure – the structure that needs to be in place to facilitate the successful operation of choice such as availability and accuracy of information and utilisation of referral systems,
  • Processes and systems – systems and processes that better support patient choice e.g. electronic referral systems (e-RS),
  • Culture and behaviours – increasing public awareness and encouraging patients to seek out and take up the choices available to them as well as increasing professionals offering choice to patients.

Choice in elective care programme

A national programme with five key work streams has been developed to address the above barriers which will improve the awareness, offer, uptake and operation of choice. The support offer will be based on each individual CCG’s requirement to strengthen the operation of choice. The work streams are:

  • Professionals – working with clinical professionals to improve the offer of choice to patients,
  • Patients – improving the awareness and confidence of patients and the public in relation to choice,
  • Systems – supporting commissioners, providers and STP footprints to improve the operation of choice within their localities,
  • Information – coordination of information improvements across NHS England, NHS Choices, My NHS and NHS e-Referrals (for patients and professionals), including the development of new metrics and dashboards,
  • Core – advice and guidance, sharing of best practice and national advocacy.

NHS England’s vision for patient choice by 2020 is that:

  • All patients are aware of the choices available to them, particularly where these are legal rights and have the information they need to make meaningful choices,
  • All GPs/referrers discuss the different treatment options available to patients, include them in shared decision making, and offer choice to patients,
  • All providers make good quality, up to date information about their services available and accept all appropriate patient referrals in line with the NHS Standard Contract,
  • All commissioners assess how well choice is working within their CCG and put improvement plans in place to address areas that need strengthening.

For more information please contact the Patient Choice Team england.choice@nhs.net.