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Last Updated: Wednesday, 31 May 2006, 11:26 GMT 12:26 UK
Q&A: Putting the patient in control
Surgeons operating
There are over 9.4m referrals for non-emergency treatment a year
The government is introducing a series of reforms designed to make the health service more patient focused.

Within the next few years patients will become consumers, choosing where they will be treated.

In turn hospitals and other NHS providers will have to compete for business or face losing money.

How is the NHS becoming more patient focused?

From the beginning of 2006 patients were given the choice of at least four hospitals for non-emergency operations.

In May, this was extended to the 32 foundation hospitals - top performing NHS trusts which have been set free from Whitehall control - and by 2008 patients have been promised the choice of any hospital in England.

GPs are currently looking at how this choice could be extended to other forms of healthcare.

Patient choice - From beginning of 2006 patients given a choice of at least four hospitals, within two years expected to be expanded to all hospitals
Payment by results - Up-and-running for elective operations, and some emergency surgery, A&E and outpatient care after being phased in during the last two years. Rest of NHS to follow
NHS IT upgrade - Various parts of the project have different deadlines. Choose and book for example is already operating in some areas, but final deadline is 2012

How will this work?

Underpinning the reform is a new system of how NHS providers are paid.

Traditionally hospitals and community care and mental health providers have been given lump sums by local health bosses at primary care trusts.

But the government is in the process of introducing payment by results, a system whereby the money follows the patient around.

A set of national tariffs has been drawn up for treatments and NHS trusts will be paid per individual cared for.

The system is already operating for elective care, and from April 2006 it was rolled out for some A&E and emergency surgery and selective outpatient care.

Adult critical care was also due to be introduced but has now been delayed as the original timetable of implementation has been shelved after problems with how the tariff rewarded specialist services.

Critics have argued it is too crude to take into account specialist care.

How will a patient exercise choice of hospital?

GPs will be the key in helping patients navigate the intricacies of the NHS.

In the long-term the job will be made easier by the 6.2bn upgrade of the NHS IT system.

Through the choose and book computer system patients will be able to choose a hospital appointment at a place, date and time of their convenience at GP surgeries.

Doctors in turn will be helped by an electronic care records system, which will allow NHS staff to access an individual's medical records anywhere in the country.

But the 10-year project has been plagued by difficulties with ministers warning it is running over budget and behind schedule.

Some people have also expressed concern about how secure the care records system is.

Will all this work?

The government says yes, but others are less sure.

Doctors have long argued payment by results could destabilise the NHS as private hospitals and treatment centres "cream off" the easiest cases, depriving hospitals of their bread-and-butter work and causing financial problems.

There are also doubts about whether the public really wants choice in health care.

A survey of 1,700 people by consumer watchdog Which?, published in 2005, found the public were more interested in good local services.

Nine in 10 put a good local hospital ahead of a choice of places, while a similar number said having good GPs close to home was better than being able to pick one from further afield.

What is more niggling doubts remain about the IT upgrade.

Two studies - one by the National Audit Office and another published in the British Medical Journal - have revealed NHS staff are not fully behind the project. Without their backing, the authors said, the 6.2bn scheme was risking failure.

Is real NHS choice possible?
14 Nov 04 |  Health

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