Patients 'not receiving benefits' of NHS reforms

Most family doctors are failing to offer patients a choice of hospital for treatment, more than two years after the Government introduced the option as part of its NHS reforms.

Barely one in 10 GPs was using the electronic "choose-and-book" system, which allows patients to pick the place, date and time of outpatient appointments, against a government target of 90 per cent, a report says today.

Under the reforms, designed to increase competition in the NHS, all patients should be offered the choice of treatment in any hospital, NHS or private, that meets NHS standards and costs, but only 44 per cent of patients said they remembered having been told of the choice.

The poor implementation of patient choice is highlighted in the report by two government watchdogs. It says market-style reforms introduced into the NHS over the past four years have cost almost £1bn to implement, but have failed to yield significant gains for patients.

Key pillars of the Government's NHS reform programme – including giving patients more choice, paying hospitals for the work they do ("by results") and increasing the role of the private sector – have improved efficiency and encouraged a more professional approach among NHS trusts. But they have not delivered the expected benefits for patients in terms of improved quality and access, the report by the Audit Commission and the Healthcare Commission says.

There has been no "clear vision" for the reforms and their piecemeal implementation has confused staff and hindered progress, it says. Because the changes were "very ambitious", it will be another two years before it is clear whether they are working to produce a more responsive service, they add.

The report, Is the Treatment Working?, comes as the British Medical Association is due to hand in to the Prime Minister a petition carrying 1.2 million signatures objecting to government plans to allow private companies to run polyclinics, a proposal made by the Health minister Lord Darzi, whose final report on the future direction of the NHS is expected at the end of the month. He has already incurred the wrath of the medical establishment over his proposal for a network of polyclinics in the capital to take on work previously done in hospitals.

Patient choice and the movement of care from hospitals to GPs are singled out as the areas where least progress has been made. However, some areas have achieved success. In Wirral, a big switch in the care of diabetic patients means 70 per cent are now managed by GPs, compared with the 70 per cent of patients who were managed in hospitals. In Peterborough, 61 per cent of patients chose an alternative to their local hospital, compared with less than half elsewhere.

Sir Ian Kennedy, the chairman of the Healthcare Commission, said: "There is no doubt the shaking up of the delivery of care ... was essential. The vision was not articulated sufficiently early, but the prospects for future progress are good."

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