Published: 06/10/2005 Volume 115 No. 5976 Page 3

The healthcare outside hospitals consultation has highlighted how poorly served the public feels by the information available on accessing health and social care - although one hopes that this will not come as a surprise to those creating the white paper (news, page 9).

But it seems clear that, as long as the care itself remains free, information asymmetry rather than deprivation is the principal cause of unequal access.

It is also obvious that, if left unchecked, the unequal grasp of information will accelerate with the introduction of patient choice. This poses a challenge for trusts - and one that, if solved, will pay far bigger dividends than formerly. As our news analysis explains (pages 14-15), hospitals competing for patients are realising that 'marketing' will not be about billboard advertising and tonnes of leaflets, but rather making sure that consumers are better informed about specific products of most use to them.

The worst thing acute trusts could do would be simply to crank up the volume, drowning the public in white noise. The key to the problem almost certainly lies with gatekeepers such as GPs and community nurses - as well as less traditional ones like employers and the voluntary sector.

This is vital: for most service users, a lack of information at the initial contact point will not lead them to fill the gap, but to give up. Ignorance tends to lead to passivity, not curiosity. And when dealing with longterm care, whether for patient or carer, the information deficit will be multiplied.

For their part, gatekeepers such as GPs need to be incentivised to make use of the information that is delivered to them, and to make available to patients the type of data that may affect referral patterns.

The white paper will not do that by itself - it is a role for primary care trusts.