Published: 25/11/2004, Volume II4, No. 5933 Page

To: Don Wise, chief executive

From: Paul Servant, operations

Re: patient choice and payment by results

Dear Don, I convened a small group to informally review some of the issues. We would hope that patients will chose to come to us because of our high clinical standards, excellent reputation, low MRSA rates, good food and easy transport links.

If only. None of these criteria will put us in a winning position of keeping, let alone increasing, referrals and income. The market is back and we will be competing for patients with other local trusts and charities.

We need to aggressively deal with the competition and generate a greater fear among patients of going to our rivals. We need to covertly promote their weaknesses to local media and opposition politicians.

We should consider a high-profile advertising and direct-marketing campaign to patients. We could dress this up in a public health message, and the impact could be impressive. I have also been in discussion with some companies about offering rewards to patients who chose us, and perhaps a loyalty card scheme.

We need to target GPs. While restrictions exist on drug companies’ relations with GPs, there are none for us. We should provide training for referring GPs according to their success in referring patients to us. I suggest a few seminars in the Bahamas, and for top GPs we could consider equipping them with ‘patient transport’ equipment to be used at their discretion, sourced from Jaguar.

There is also an opportunity for us to play the choice game ourselves. We have a range of tertiary centres we currently refer patients to, and some informal discussions are taking place to see what sort of discounts and benefits the trust can accrue from concentrating our referrals to the most ‘enlightened’ specialist centre.

Finally, we are drawing up a list of key staff at our competitors, who we may wish to poach. Foundation trusts are prohibited from this; we are not.

Decisive action in this area could cripple at least one trust’s profitable cataract service.