The proportion of patients who said they were offered a choice of provider on referral has slightly fallen since 2010, despite a coalition’s commitment to oversee an increase.

Data collated by HSJ from the national inpatient survey (see table, below) shows the proportion falling year on year since 2010, from 32 per cent that year to 27 per cent in 2013.

As the changes are slight, they may represent a steady proportion of patients actually being offered choice. However, the drop in patients’ perception of choice does represent a change in direction from the trajectory shown in the national survey on choice between 2006 and 2010.

That survey, which was stopped in 2010, showed an increase in the proportion of patients being offered choice in its last four years, from 36 per cent in 2006 to 49 per cent in its final year.

Performance on patient choice was managed closely until 2009, with some areas seeing significant increases. The government’s Liberating the NHS white paper in 2010 said the previous government had made “limited progress” on choice of provider and “momentum has stalled”.

“It has remained the case for several years that just under half of patients recall that their GP has offered them choice,” it added. “The department will increase that significantly.”

Don Redding, policy director of patient representative group National Voices, said the figures showed the policy of centrally encouraging choice of provider for first elective appointments was “a blunt instrument” which had “limited effect”.

Patient survey

He said patients may be keener to choose later in their treatment when they have “become a bit more expert”.

Mr Redding said it was more important to promote personalised care planning, which would involve patients being free to make choices when they wished.

Bill Morgan, founding partner of consultancy Incisive Health and a special adviser to Andrew Lansley when he was health secretary, said the figures suggested the proportion offered choice was stable.

He said the performance management of GPs on offering choice needed to be “centrally driven”, and this had not happened since 2010, although until 2012-13 the government had pushed the introduction of new providers.

He said that under the Health Act 2012 the “choice mandate” set by the Department of Health and a “choice and competition framework” agreed by NHS England and Monitor should be used to require commissioners to increase choice. This was not currently being done effectively, Mr Morgan claimed.

A Department of Health spokesman said: “All GPs should be giving patients a choice on where to be treated in the NHS and we expect them to act on these results.”