By Ed Grunill, Senior Account Director at ZPB
It's back.
Patient Choice is being hailed as the key to service improvement and a fast track to reducing waiting lists. Looking back to the Labour government of 1997-2010, patient choice was a central pillar of their health strategy and unsurprisingly it’s back again in 2024. As Wes Streeting said in his recent conference speech: “Our ten-year plan will give all patients – rich and poor alike – the same information, the same choice, the same control.”
How does this work on the inside? The Provider Selection Regime (PSR) - the new procurement framework through which the NHS procures services - includes choice within the procurement routes reaffirming the NHS Choice Framework within service provision. Alongside the PSR, the independent patient choice and procurement panel provides independent advice to relevant authorities in relation to some provider selection decisions. Recently a landmark ruling by the panel on ADHD services, made it explicit the NHS cannot prevent suppliers from offering services where patients have a right to choose.
To understand these significant changes, ZPB brought together senior leaders from across the healthcare landscape for a roundtable discussion about choice, the PSR framework and what this means for the future of healthcare. The discussion was led by Andrew Taylor who is chair of NHSE’s Independent Patient Choice and Procurement Panel.
With a spirited debate across the table, here are five key points from the session:
1. There are challenges around getting patients to choose where to get treatment
While the roundtable recognised the definite potential for patient choice to positively influence the development and delivery of services, we also discussed the challenges around patients’ understanding of choice.
The NHS Choice Framework sets out when patients have the right to choose services. But research has shown that choice is poorly understood by people at the point where they are choosing a service [i]. Information about services, service quality and access is hard to come by, owned by multiple agencies and often HCPs are not invested in supporting choice.
To remedy these issues, the group identified that someone needs to take clear ownership for explaining the right to choose and provide useful information about services to the public and importantly, how they access services.
2. How consumer advocacy became a transformative force in Autism and ADHD assessments
One area where we’ve seen active choice is in the assessments of people with autism and ADHD. In this area of healthcare, patient choice has already begun to reshape the sector, largely driven by the persistent advocacy of patients and in particular the parents of young people who are seeking assessment, diagnosis and support.
Frustrated by long waiting lists – often stretching for years - many parents have turned to private healthcare to secure faster access to assessments for their children. Recent rulings from the PSR panel have helped push this issue into the spotlight, with collaboration between NHS and private sector now the established norm.
During the roundtable, participants highlighted this patient advocacy as crucial in realising the power of choice across different patient pathways. The bigger challenge attendees highlighted is getting GPs and other HCPs on board and engaged so they offer choice to the people in their care, recognising that they are not incentivised to consider choice.
3. Providers need to behave as good corporate citizens: building partnerships and maintaining reputation with commissioners
Participants at the roundtable recognised the importance of ethical corporate behaviour to build trust and partnership working with NHS partners as well as affirming positive values and trust with consumers. Simply ticking the required boxes to secure a contract isn’t enough. Private companies must focus on delivering true value to patients, working in tandem with the NHS to ensure quality outcomes recognising that independent providers are often accused of undertaking more straightforward patient work and therefore shifting the burden of complex patients onto NHS services.
The PSR aims to foster fairness and transparency, with decisions being published and a clear record of how service providers are chosen. Ethical providers - those who prioritise patient care over profit - designing services around patient need and demonstrating their understanding of the system challenge and diversity of patient care, should hopefully thrive in this environment.
4. How do providers succeed in the new world of choice?
Providers need to build up brand recognition and familiarity with people before and when they are looking for care. This will help get your brand to the front of mind of patients as they choose your service. Deep understanding of audiences alongside insight into their motivations, influences and influencers all contribute to developing successful activations.
Another route to market is developing productive partnerships, as illustrated by the important role optometrists play in terms of ophthalmology services, relying on time poor HCPs to discuss choices for care is not likely to deliver results.
Providers should consider how they can demonstrate to commissioners and HCPs how they are aligned to NHS values, meet NHS policy requirements and support the reduction of health inequalities [ii].
5. What’s next for patient choice?
We’ve seen the impact of patient choice across neurodivergent assessments and ophthalmology. Many services come under the banner of patient choice but the emphasis on choice is currently limited. Looking ahead other areas which could benefit from a bigger emphasis on choice include weight management services and diagnostics but this needs to happen in tandem with adequate funding and commissioning so demand can be met.
ZPB understands healthcare and we know that healthcare companies need a direct-to-consumer offer, and a proposition for the NHS and other partners; all the while establishing credibility with the medical community, the CQC and the policy influencers at ICBs, the Department of Health and NHS England. Send us a note to see how we can support your organisation to succeed in the changing healthcare environment.
[i] https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/- see point 3. ‘be a good corporate citizen’
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