Pick your own surgeon – a new future for the NHS

Patients will be able to choose which surgeon they want to carry out their operation under changes to the NHS designed improve quality of treatment.

A constitution for the NHS will give patients new statutory rights of choice for the first time, including the right to express a preference for the GP they want to see. According to plans outlined by ministers, they will be helped by their doctors to choose the right surgical team with data on survival rates, the average length of stay in hospital, the frequency of readmission, the incidence of hospital-acquired diseases and patient satisfaction ratings.

Patients' ratings of the care they receive will also be used to hand out up to £9m in bonuses to the best healthcare units and GPs. Information on service quality will be displayed on "dashboards" in hospitals, GP surgeries and the web.

Hospital units which make blunders that should "never happen", such as removing the wrong leg in surgery, could lose the additional sums – about 3 per cent of the hospital budget.

Lord Darzi of Denham, appointed last year by Gordon Brown as a Health minister to oversee the reforms, said: "This is about giving more clout to patients. By measuring quality across the service and publishing that information for the first time, both staff and patients can work together to make better informed choices about their care."

Patients will also be able to choose their GP practice under the NHS constitution. "You have the right to choose your GP practice and to be accepted by the practice unless there are reasonable grounds to refuse in which case you will be informed of those reasons," it says.

Ministers have dropped the idea of penalising patients who refuse to quit smoking after a heart attack or refuse to slim if they are diagnosed as obese. The constitution says: "The concept of 'responsibilities' was thought to be sensible and fair. Discussions with patients, the public and staff also indicated that while some sanctions may be acceptable, responsibilities should mainly act as a guide for individual behaviour."

The Darzi report will be followed by an NHS Constitution Bill this autumn, which seeks to end the "post code lottery" over expensive drugs being refused by some primary care trusts, even after the drugs have been approved by the National Institute for Clinical Excellence (Nice), which issues guidance on the effectiveness of treatments. "If the local NHS decides not to fund a drug or treatment you and your doctor feel would be right for you, they will explain that decision to you," says the constitution.

Personal health budgets for people with conditions such as diabetes or multiple sclerosis will also be piloted to give patients greater control over their care, in a move welcomed by the MS Society's chief executive, Simon Gillespie.

Lord Darzi, a surgeon, consulted more than 2,000 NHS staff at all levels, but some experts said it would be difficult to meet the high expectations of patients.

Andrew Lansley, the shadow Health Secretary, claimed yesterday that the plans will lead to the closure of 1,700 family doctor surgeries. Lord Darzi called that claim "nonsense".

How the changes will affect patients

Seeing your doctor

Seeing a GP could become a very different experience from the one we are used to – the little surgery run by a handful of doctors and a couple of overworked receptionists who struggle to give you an appointment at a suitable time. In future there should be a "polyclinic" near you, open every day from 8 am to 8 pm, regardless of where you are registered with a GP. While you are there, you could try some of the other NHS services, available in the same building, such as having your mental health assessed, or taking advice on social care or healthy living. These polyclinics are, however, up against stiff opposition from doctors.

The new NHS constitution will include a "right to choose", which should mean you never have to put up with unhelpful receptionists, or uncaring or incompetent doctors. When you visit a surgery, you have the right to choose which doctor will see you, and if you don't like one practice, you could visit a website called NHS Choices and hunt for another. And the funding will follow the patients, so losing you as a patient will cost the surgery as an inducement to them to look after you properly. You will also have the right to check your medical record online, and correct it if necessary.

The right medicine

If your doctor or clinician says you need a particular drug or treatment, and if it has been approved by the National Institute for Health and Clinical Excellence (Nice), you will get what you need. But there is also a notorious "postcode lottery" under which a drug that is awaiting appraisal by Nice is available in some places but not others. To end that, Nice is being expanded, and a new National Quality Board is being created to advise it on priorities, so it can do its job more quickly.

Hospital visits

Most people like the idea that there is a general hospital nearby which can handle anything from a simple to X- ray to major heart surgery, but Lord Darzi argues that this is not the best way to run a health service. People who need something as simple as a blood test, or an X-ray should not go to a hospital at all, he says: the equipment should be available at a doctors' surgery or health centre, or brought to the patient's home.

People who need what are now relatively simple operations, such as the removal of a cataract, should be also be kept off the wards and given day treatment instead. That is better for the patient, and much more economical. At the other extreme, people with potentially fatal conditions such as heart attacks and strokes should not be in general hospitals but specialist centres, even if that means longer journeys for visitors.

For those who are waiting in a hospital, the "clinical dashboards" should become a more common sight. These are large plasma screens that give information updated every 15 minutes, such as how long a patient can expect to wait.

The right to choose applies to hospital patients as well as doctors' patients. And if you don't like the way the hospital treats you, you will be able to get your own back by complaining. "For the first time, patients' own assessment of then success of their treatment ... will have a direct impact on the way hospitals are funded."

Bespoke care

In Germany, people with long-term illnesses are given help by health professionals in drawing up their own personal care plans to give them greater control over their lives. In this country, such plans are very rare, but over the next two years, every one of the 15 million people with a long-term condition should be offered the chance to develop a plan which will be updated regularly, with help from a named professional. The NHS is also exploring the possibility that patients with "fairly stable and predictable conditions" such as diabetes or multiple sclerosis can be allocated a personal budget so they can choose treatments.

Staying healthy

Originally the NHS was conceived as a service to heal the sick, but recently attention has shifted towards preventing people from falling ill in the first place, by encouraging a healthy lifestyle and discouraging or even punishing unhealthy habits. Today's big target is obesity. If you are overweight, you may feel a new entity called the Coalition for Better Health breathing down your neck, trying to persuade you to eat more healthy food and take more exercise. From next year, three million people a year aged 40 to 74 will be invited to take a free blood test, to check whether they at risk from one of the big killers – heart diseases, stroke and diabetes.

The whole country will also be bombarded with warnings against overeating and other bad habits, in a "Reduce your Risk" campaign. Other habits they will try to persuade people to break apart from eating junk food will include smoking, drug taking and excessive drinking.

NHS staff in the East of England have set an example the Government wants others to follow, by setting themselves a target of reducing the number of smokers in their region from a million to 140,000.

Andy McSmith

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