As Andrew Lansley’s plans for an overhaul of the NHS over the next five years continue to emerge and crystallise in the UK, many of us are scratching our heads and wondering what precisely this will mean for us. What is going to be important as the new system unfolds? Lansley’s NHS White Paper, officially known as Equity and Excellence: Liberating the NHS, will as we know, lead to major upheaval as England’s 152 Primary Care Trusts (PCTs) disappear alongside the 10 Strategic Health Authorities (SHAs), to be replaced with a number of GP consortia. Even as we speak trial versions of GP Consortia (pathfinders) are in operation, currently looking after roughly half the population.
The White Paper also includes patient choice as a central tenet coining the catchy phrase – ‘no decision about me without me’. But is this merely empty rhetoric or will it actually lead to tangible improvements in patient experience and the quality of healthcare? No one can doubt the logic of encouraging patients’ involvement in health decisions to help build ownership and responsibility. However, some fundamental questions remain about extending patient choice… Do patients really want choice? Can patients make truly informed choices – and can this all be done within a cash-strapped NHS?
The Patient Choice Index (PCI)
In an exclusive partnership with PMGroup, Insight Research Group will report the findings of what will be known as The Patient Choice Index, a six-monthly survey measuring the impact of these changes as they evolve and develop. The Patient Choice Index will track shifting attitudes and behaviours regarding healthcare choices among UK adults (who have visited their GP in the past year). This is our initial benchmark report timed just as the government’s consultation period has come to a close. Here is the first set of findings of the three planned surveys this year.
The Patient Choice Index registers a score of 30, meaning that 30 per cent of surveyed adults who had seen their GP at least once during the past year had actively sought information about their healthcare decisions – whether that was looking into which surgery to join, deciding on a consultant team/hospital to attend or getting information on a medication.
Over the next year we will see to what extent, if at all, this set of reforms has broadened peoples’ horizons about the possibilities and options offered within the NHS and their increased ‘centrality’ as consumers of healthcare provision. To what extent will the PCI rise? Watch this space.
The media will play a big part in any changes that may emerge by shaping public perceptions and thereby altering expectations from the healthcare system. In addition, increased competition among ‘suppliers’ of healthcare may encourage patient involvement in choosing not only their provider but also inputting into their healthcare plan. It would seem prudent in this context for pharma companies to ensure their brands are aligned to patients’ needs, wishes and aspirations and that they are clearly communicating this.
Alongside the main Patient Choice Index, there are several different findings that the survey will reveal. The following are key areas where we might expect public opinion to change over time as the reforms take hold and the current views of respondents as elicited through the first survey.
• Do patients want choice?
Question: We asked people how they feel about having more choice about how their health is managed by the NHS
Statistic: Currently, 60 per cent feel positive about having more choice
Analysis: The public welcome choice because their perception of being given an option leads them to think standards will be higher. Although, at this point, exactly what it means for them and how this greater choice will manifest itself is still somewhat unclear. We will monitor how peoples’ feeling about having more choice changes over the next year.
• Do patients speak up?
Question: Our survey asked to what extent are you – the patient – likely to put ideas forward to your GP or voice a preference for a hospital or medicine
Statistic: Our research shows people do not tend to voice a preference for a particular medicine (75 per cent) or hospital (84 per cent) but would feel comfortable putting ideas forward to the GP (72 per cent).
Analysis: Although many patients would put ideas forward if they had the opportunity, the key question is… Will GPs in this new world give them that opportunity to do so? If they do, how will patients deal with it? What would that mean for the 8-10 minute consultation?
• How will the ‘Information Revolution’ unfold?
Question: Patients were also asked how informed they felt about their condition
Statistic: Just 6 per cent said they felt they were not informed at all about their current condition with the rest stating they were fairly (33 per cent), very (43 per cent) or extremely (18 per cent) well informed.
Analysis: Despite the majority feeling relatively well informed, we see this rarely translates into them making health choices. In light of this, will patients engage with the ‘information revolution’ if they feel satisfied with their current knowledge levels? And if they are truly informed what will empower them to take a more active role? Does more information actually inform or confuse?
• To choose or not to choose?
Question: With regards to their choice of GP surgery, hospital/consultant team or medicine, we asked whether patients would want a choice or not
Statistic: As it stands the answer ‘I welcome choice but don’t know where to look for information’ came out on top (~40 per cent); ‘I welcome choice and know exactly where to get the information I need’ (34-36 per cent) came in second and ‘I don’t want choice’ came a close third (23-27 per cent) for each scenario.
Analysis: Although a third claim to know where to go for information and what to get, the majority of the public clearly feel a bit in the dark when it comes to their healthcare. The government is aiming to provide an ‘information revolution’ to enable patients to make informed choices but it is still largely unclear how this will look and how pharmaceutical companies can operate within this framework. Over the course of the research we will see whether there is light at the end of the tunnel for patients and for the pharma industry.
• Aren’t GPs already overworked?
Question: Patients were questioned on whether they feel GPs should be ‘freed up’ from a business focus to treat patients
Statistic: Currently, 82 per cent said they should.
Analysis: Though not all GPs will be involved in the decision-making within consortia, there is going to be an overall shift towards them becoming more bureaucrats than practitioners. It seems there is still some way to go to convincing the public that giving GPs the money and effectively making them managers is the right way forward. The role of pharma companies is very likely to change with this reform with greater emphasis on supporting and helping GPs and their consortia opposed to simply supplying them medicines.
• Are patients happy with the NHS as it is?
Question: Our survey captured attitudes towards the NHS
Statistic: Currently, the nation is split with 51 per cent saying they were happy with the NHS as it is.
Analysis: It will be interesting to see if and how this evolves over time as the reforms take shape.
It was very clear that a majority of patients welcome increased choice with open arms but would still like the option of having the GP there on hand to recommend, influence and help shape their choices. A significant majority of people liked the idea of having a joint decision process when it came to their treatment and choosing the most suitable medicines. Words to describe how patients felt about having input into the choice of their medicine were very positive on the whole. ‘Empowered’, ‘in control’ and ‘responsible’ were among the most popular descriptions.
Overall, it appears that the patient choice agenda is welcome shift in the right direction. Generally though, while in principle patients want choice, in practice it’s a little more difficult for them to know where precisely to go to get what’s needed to better inform that choice. It is clearly still difficult for patients to initiate dialogue with their GPs, so GPs will need to start these conversations. The question here is will they find the time or have the inclination to do so?
For pharmaceutical marketers, the challenge is to understand how the extension of patient choice will develop and to harness the opportunities that this brings.
The Author
Vivienne Farr, director, Insight Research Group, the largest healthcare market research agency in the UK.