Patient choice for older people in english NHS primary care: theory and practice.

Andrew J E Harding,Edwin R Van Teijlingen,Sam Crowe,Sheetal Sharma,Frances Sanders,Di Galpin,Sue Baron,Cate Wood,Antonieta Medina Lara

doi:10.1155/2014/742676

Abstract

In the English National Health Service (NHS), patients are now expected to choose the time and place of treatment and even choose the actual treatment. However, the theory on which patient choice is based and the implementation of patient choice are controversial. There is evidence to indicate that attitudes and abilities to make choices are relatively sophisticated and not as straightforward as policy developments suggest. In addition, and surprisingly, there is little research on whether making individual choices about care is regarded as a priority by the largest NHS patient group and the single largest group for most GPs—older people. This conceptual paper examines the theory of patient choice concerning accessing and engaging with healthcare provision and reviews existing evidence on older people and patient choice in primary care.

Highlights

Market reforms in the English National Health Service (NHS) have been implemented to make services more responsive [1]
There has been little research on whether making individual choices about care is regarded as a priority by the largest NHS patient group
This paper examines the theory of patient choice as a means of accessing and engaging with healthcare provision and reviews existing evidence and research on older people and patient choice in primary care

Summary

Introduction

Market reforms in the English National Health Service (NHS) have been implemented to make services more responsive [1]. Since the internal NHS market reforms of the late 1980s, recent policies have directly and indirectly encouraged the entry of alternative third and private sector providers [2] These reforms position patients as consumers who (a) make choices instead of their medical and healthcare professionals and (b) are increasingly expected to navigate local health economies. The 2010 Coalition Government White Paper stated that “In return for greater choice and control, patients should accept responsibility for the choices they make.” [2]. This paper examines the theory of patient choice as a means of accessing and engaging with healthcare provision and reviews existing evidence and research on older people and patient choice in primary care

Theory

Patients Are Different from Consumers in Other Markets

Choosing What—Provider or Care?

Evidence and Practice

The Way Forward