Thomas Cawston is Head of Health at Policy Exchange.
Winter is not normally a time for good NHS news stories. During recent weeks, there has been the usual deluge of “A&E in crisis” headlines and what seems like rolling news coverage of reporters camped outside hospital doors as the queues get longer and longer.
With the winter weather forecast to really bite in the next month, health ministers are braced for more bad news as emergency departments are pushed to the limit. But here is a piece of New Year’s cheer. Today, what could be one of the Coalition’s most important health reforms comes into effect – something that might actually make a difference to patients.
Ever since the creation of the NHS patients have been able to choose their GP, although this choice has always been a bit of an illusion. In practice, patients have only been able to pick a surgery near to their home address. For the vast majority of patients “choice” has been limited, if not non-existent.
While this may have made sense in the post-war era, when people lived and worked in the same place and seldom moved, society has come a long way since 1948. Today, millions of people commute to work, many have second homes and children travel miles to go to the school of their choice.
So for working families, the nearest GP might not necessarily be the most convenient. As Andrew Lansley suggested back in 2009, the practice boundary system had become a “solid wall of defence against patient choice”.
Yet getting GPs to open up their lists has been a long time coming. The Conservatives proposed giving patients more choice by scrapping fixed boundaries altogether in Opposition. During his time as Secretary of State, Andy Burnham also saw also saw the need for patients to have more choice of GP services. However, he was unable to force changes on GPs before the 2010 election.
From the outset, the Coalition were determined to finish the job. The Coalition Agreement pledged to “give every patient the right to chose to register with the GP they want, without being restricted by where they live”. Yet in the face of doctors’ resistance to his wider NHS reforms, Lansley stepped back from abolishing practice boundaries.
Instead GPs accepted a bit more flexibility for patients who move address in the shape of “outer practice boundaries”. Jeremy Hunt picked up the baton, and in 2013 got GPs to accept patients outside their boundary areas. Many months later, and after being delayed at least once, the reform finally comes into effect this January.
While voters famously get nervous about the future of their local hospital, nine out of ten interactions with the NHS actually take place in GP surgeries. With more and more people finding it harder to book an appointment, particularly outside working hours or at weekends, today’s change to give patients more choice of GP is well timed. In recent years, patient satisfaction with GP opening hours has started to fall, particularly in London and the South East. Many also see poor access to general practitioners as a major cause of rising pressure on A&E. Hunt himself admitted to taking his children to A&E rather than face the wait for a GP.
Improving access to primary care has become the new political battleground. Both David Cameronand Ed Miliband have set out door step friendly policies last year – whether by guaranteeing an appointment in 48 hours or seven days a week.
Yet, as the experience of the last government testifies, targets can only achieve so much to improve services. Creating a bit more patient power will create incentives for GPs to keep their doors open longer, and of course allow families the chance to register at surgeries that meet their needs. Prying open the closed shop of primary care will also mean that the best surgeries will be able to attract more patients and thrive.
Giving patients more choice of GP has been a key pillar of health reform for years, and today’s change is only a start. While many patients would love the ability to choose a new surgery that suited their needs, GPs have to “opt in” into the policy.
Unfortunately, as many as half of GPs do not intend to accept patients from outside their practice boundaries claiming, there is no public appetite for the change. Hopefully, in time more surgeries will welcome a bit of healthy competition when patients begin to demand their right to choose. Yet despite the vital role choice can play in pushing up standards, it is a shame that many patients probably have not heard of today’s change.
It has become the accepted wisdom that the Government wants to keep a lid on negative NHS press in the next few months. Certainly, following the trauma of getting the Health and Social Care Act through Parliament, the Coalition has barely mentioned NHS reform or the role of competition in improving services. Yet with the public clamouring for easy access to GPs, this is a reform they should not be ashamed of.