Two-thirds of the 67 PCTs surveyed said they struggled with delivering equity of choice. Over half had not conducted any assessment to identify who might need support to make health choices and two-thirds had not commissioned any new services to support choice.
The King's Fund says the situation threatens to undermine the government's ambitions to use choice to make the NHS a fairer service.
Report author Ruth Thorlby, King's Fund fellow in health policy, pointed out that PCTs are responsible for making sure everyone has an equal opportunity to choose. This could be by offering extra help where appropriate, for example to older people or people with disabilities or language difficulties.
She said: 'Some PCTs are providing support but the majority are not. This is possibly because getting the electronic systems, such as choose and book, to work and convincing GPs to come on board, is a bigger priority. While it is too early to tell whether patient choice is creating fairer outcomes for people, ensuring that everyone gets an equal chance to make a choice is already proving testing for the NHS.'
GPs were seen as crucial in helping patients make a choice, yet their resistance to choice overall was the most frequently cited barrier to equity. One PCT said: 'Many GPs seem to have a philosophical aversion to patient choice and are reluctant to engage in an informed conversation with patients about it.'
PCTs said it was difficult to monitor whether GPs were offering choice. One said: 'We know there is a variation between some GPs' assertion that choice was offered and the patients' perception of
that offer being made.'
GPs' hostility was compounded by the enduring problems with IT and with delays experienced by PCTs in getting leaflets and other information to disseminate.
In many areas PCTs had focused on IT problems rather than equity.One PCT said: 'The focus to date has been on rolling out booking (to DoH targets that we consistently fail to hit because of technical problems with the hospital software). We have therefore focused very little energy on choice.'
In some places, professionals were not engaged with the idea of choice, especially where there were only one or two local providers.
Few dedicated managers for choice
Very few managers have the luxury of being responsible solely for choice. Of the 67 PCTs surveyed, only 10 had a lead manager just for patient choice. The other 85 per cent also had responsibility for other functions, most commonly commissioning. The size of teams devoted to choice at PCT level ranged from 0.2 whole-time equivalents to 6.75, with an average of just
under two full-time posts per PCT.