NHS hospital treatment and information about specialists
Updated June 2008
- Introduction
- Patient Choice
- Your Time in Hospital
- Information about Surgery
- Some Useful Websites Listing Specialists
- Second Opinions
Introduction
In the UK, the most common route into secondary, or specialist, care is via a referral from a general practitioner. This is because GPs hold patients' medical records and have an overview of their patients' health and treatment. They are therefore best placed to assess, with the patient, whether a specialist referral is necessary and, if so, to which specialist or further services patients should be referred.
However, patients do not require a GP referral to access certain hospital services, such as sexual health clinics and accident and emergency departments..
Before any referral, a GP may suggest that a patient explores other treatment options or tests to see if their condition improves.
Patient choice
- The background to patient choice
Key Department of Health (DH) priorities were that patients should be provided with more information to help them make choices about their treatment, alongside better healthcare for those suffering from long-term medical conditions, such as diabetes and heart failure. A greater emphasis was to be placed on the prevention of disease and on tackling health inequalities within the NHS.
Two, more recent, DH reports provide an update on the development of patient choice in the NHS since 1 January 2006:
- Choice Matters (Ref 3) includes feedback from patients and staff after choice at the point of referral was first introduced across the NHS in England.
- Choice matters 2007–08: putting patients in control (Ref 4) provides an up to date summary of the implementation of patient choice initiatives in the NHS.
There is further information about current DH policy on patient choice on the Department of Health's website.
NHS Choices is a new-look NHS website launched in June 2007 which focuses on patient choice of services. The site allows patients to compare hospitals; plan treatments; find health services in the GP and hospital sectors and find information on healthier lifestyles. You can keep up to date with developments through a regular newsletter giving details of new features on NHS Choices.
Finally, The King's Fund, an independent charity specialising in healthcare research, also has a useful section on its website which looks at the policy implications of choice for patients.
- Choose and Book
This national electronic service offers a choice of place, date and time for first outpatient appointments. It allows patients to choose their initial hospital appointment, and book it on the spot at the GP surgery, or later on the phone or via the internet. Primary Care Trusts (PCTs) are responsible for commissioning these hospital services for patients.
When making a booking for elective (non-emergency) treatment, patients can choose from a range of providers which together constitute the Extended Choice Network (ECN). These providers make appointment slots available through the national menu of the Choose and Book service. The four categories of provider are:
- NHS Foundation Trusts: as of June 2007, 40 of the 67 Foundation Trusts were listed on the national Choose and Book menu;
- NHS Trusts: Trusts fulfilling certain conditions can upload appointment slots to the national menu on a specialty-by-specialty basis (orthopaedic surgery from July 2007, with other specialties to follow during 2007/8);
- Independent Sector Treatment Centres: there are now 16 ISTCs in the ECN with services published on the national menu;
- Independent Sector providers: by June 2007 there were 71 facilities approved to deliver NHS services across the country with 44 listed in the national menu.
Source: Choice matters 2007–08: putting patients in control (Ref 4)
Currently 50% of GP referrals to hospitals and clinics are managed through the Choose and Book electronic system (Ref 5). After a GP using the Choose and Book system has discussed with a patient which hospitals or clinics are available to provide their specialist treatment, the GP can then generate an electronic appointment request (URBN) and a password for the patient.
If the patient does not make a choice of provider at that time, the GP provides the patient with information about the clinically appropriate choices. The patient can then book their appointment at a later time, either via the NHS Choose and Book Appointments Line (Tel 0845 608 8888 (7am - 10pm daily); online via the Choose and Book website; or by contacting their hospital of choice directly.
Alternatively, in some GP practices, the receptionist or secretary can make the appointment on the patient’s behalf.
The NHS Choices website now provides information on waiting times, hospital ratings and general cleanliness, using data compiled by the Healthcare Commission on hospital performance and MRSA rates.
- Extended choice
The NHS Choices website now has a facility whereby patients can compare the clinical quality of hospitals offering the most common treatments. The website also has information about other facilities (such as car parking and transport links) and patients' views of individual hospitals.
NHS trusts and organisations that provide NHS funded health care will also be allowed to promote their services by advertising information about factors such as waiting times, surgical outcomes, and rates of hospital-acquired infection. Testimonials and endorsements from celebrities, medical experts, and patients will also be permitted where they have had direct experience of the care provided by the hospitals concerned, and they are not paid to give their views.
A new Code of Practice has been published by the Department of Health (March 2008), setting out the rules governing the advertising of NHS-funded services to patients. This is primarily to ensure that NHS providers are not misleading patients about the quality of their services in any way.
Although the BMA welcomes any measure that will help patients to make a more informed choice about where they should go for their secondary/hospital care, it does have some concerns regarding the accuracy and reliability of the data currently available, as outlined in a recent BMA press release (March 2008).
In England, referral management centres have now been set up by some Primary Care Trusts (PCTs), designed to direct patients that have been referred by GPs for further treatment, to the most appropriate provider of care. There have been concerns expressed that this system could, in practice, lead to less choice for patients.
The BMA has produced a short briefing paper on referral management standards and ethics given that, with these new referral management centres, it is less clear whether the responsibility for a patient lies with the general practitioner or the consultant during the intermediary referral process.
The BMA's Central Consultants and Specialists Committee and General Practitioners Committee have produced a joint document, which aims to set out the key guiding principles that should apply to referral management schemes.
Your time in hospital
There are three different types of hospital admission depending on the nature of tests or treatment required (Ref 6):
outpatient - if you are referred to see a hospital consultant for a specialist opinion, your visit to the consultant is an outpatient appointment. You do not need to stay in hospital.
day patient - if you need a hospital bed for tests or surgery, but do not need to stay overnight for surgery, you will have a day patient appointment (also known as a day case).
inpatient - if you need a hospital bed because you have to stay in hospital for tests or surgery, you will have an inpatient appointment.
Some NHS hospitals are teaching hospitals with links to medical schools. This means nurses, doctors and other health workers carry out part of their training within the hospital and medical students may well be part of the team of doctors who are looking after a patient.
Patients may wish to obtain information that will make their hospital stay safe and comfortable. This would include finding out if they should avoid food and drink before an appointment; informing the hospital of any other conditions or allergies they may have; and letting the hospital know of any medication they may be taking. They may also wish to find out if soap and towels are to be provided by the hospital or by patients. If they are to undergo a procedure or operation, patients will generally be asked to sign a consent form.
This kind of information can be found in the recently produced Hospital Companion produced by the consumer group Which? (Ref 7). The Companion contains useful guidance to help patients get the information they need to feel more confident about their stay hospital. The document includes information on standards of care; a 'who's who' guide to healthcare professionals within a hospital; and the daily routine one might expect during a hospital stay.
In addition Which? has produced a document containing key questions for patients to ask during their time in hospital
The Department of Health has also produced a guide called Questions to Ask, aimed at helping patients get the most out of their appointment with their doctor or health professional, while the Patients Association has produced a similar guide You and Your Doctor; this includes advice for patients who have been referred for specialist treatment.
Information about surgery
The Royal College of Surgeons (RCS) has a Patient Information section on its website, which enables visitors to the site to access a wide range of information on surgery and related issues. The following guides were produced by the RCS's Patient Liaison Group:
- Child Patient Rights and Responsibilities
- Children Going into Hospital
- Having an Operation?
- Patient Rights and Responsibilities
With regard to cosmetic surgery, the Department of Health has produced a checklist for patients of questions they should consider asking potential providers before having a cosmetic surgery procedure done.
We provide more information on Cosmetic Surgery guidance in our web section: An A-Z of common medical queries and useful websites.
Heart Surgery: success rates
Data on success rates for various types of surgery is generally not available to patients in the UK. However, in April 2006, the Healthcare Commission and the Society for Cardiotheroracic Surgery launched a website with information on the outcomes of heart surgery in England and Wales, specifically for coronary artery bypass grafts and aortic valve replacement operations. This is the first such database of its kind in the UK and can be found on the Heart Surgery in Great Britain website.
Patients and the public can see the patient survival rates for all Cardiac Units in the UK by reference to the range of expected outcomes. For 29 out of 39 hospitals, data is also available on the performance of individual heart surgeons.
The information takes account of the fact that some patients are more likely to survive than others, depending on the type of operation involved and factors such as age, severity of illness and other medical problems; this data is updated regularly.
Information on survival rates for every specialist children's heart centre in the UK has also been made available online, developed by the Society of Cardiothoracic Surgeons of Great Britain and Ireland in conjunction with the British Congenital Cardiac Association. This information can be found on the NHS Congenital Heart Disease Website.
Private healthcare provider Spire Hospitals (formerly BUPA Hospitals) has also made information available to patients on treatment outcomes (for example on success rates following hip and cataract surgery and on MRSA rates in their hospitals).
Some useful websites listing specialists
The BMA is often approached with requests for information about specialists working in particular areas of medicine. However, the BMA is not a clinical organisation and we cannot provide members of the public with lists of specialists working in different branches of medicine and surgery. In addition, as we are a voluntary membership organisation, all information about our members is confidential.
For patients who wish to know more about the specialist to whom they have been referred, or to locate a particular consultant for private treatment, the following websites provide information that patients may find helpful.
(Please note that the websites listed below are unrelated to the BMA and their inclusion here does not imply BMA recognition or approval. We can accept no responsibility for their content).
www.drfoster.co.uk
Dr Foster Intelligence is an independent organisation which collects and analyses information on the availability and quality of health services in the UK. Their website has a section specifically for the public, including a resource which enables patients to find a named consultant or consultants specialising in a particular condition.
This Consultant Guide provides information on consultants who have special interests or training related to particular medical conditions; approximate waiting times to see specific consultants; and which consultants hold clinical excellence awards.
Once patients have selected a body area and specialism within that category (eg one can select lungs/tuberculosis), consultants can be searched for by postcode. A system of ticks is used to indicate those consultants who have expressed special interests relevant to a particular operation/diagnosis, with three ticks representing the closest match.
All information in the Consultant Guide comes directly from the hospitals and consultants themselves.
There is also a useful A-Z of Health on the Dr Foster website, providing information on common medical conditions and treatments and which hospital departments and specialist consultants normally deal with these conditions.
Finally, their website also includes a Hospital Guide, and further guidance on finding a birth unit, a complementary practitioner, a breast cancer clinic and/or an infertility clinic.
The Dr Foster Hospital Guide, mentioned above, assesses the quality of care delivered to patients at both NHS and private hospitals around the UK, based on a number of different key variables such as waiting times for particular procedures, infection rates, re-admission rates and mortality rates (some information is available for England only).
The Guide covers every acute hospital with more than 300 beds in the UK (in addition to some smaller acute hospitals which offer specialist services) and every private hospital with more than 30 beds. Patients and the public can access the data available in the Hospital Guide and search for the relevant information by hospital name.
www.specialistinfo.com
This website, created by Healthcare Knowledge Ltd, was the initiative of a GP and a database publisher. It is primarily aimed at other doctors and healthcare professionals, although it is also accessible by members of the public. It lists over 36,000 consultants, and one can search by name, special interest, hospital and/or NHS Trust. The website also lists over 37,000 GPs in the UK and more than 2,000 consultants in the Republic of Ireland.
There is now a small charge for accessing information from this website (including the option of a fee for daily access only). If you have any difficulties using the website you can contact Healthcare Knowledge Ltd on Tel (01423) 562003.
The BBC News Health website has recently added a section to its site, looking at different medical specialties and at what specialists, such as dermatologists, oncologists and plastic surgeons, do in the course of their work, in addition to other health professionals, such as podiatrists. This can be found on the BBC's Inside Medicine web resource.
The medical Royal Colleges are involved with the postgraduate training of doctors and have responsibility for continuing medical education and setting standards of medical practice in the various medical and surgical specialties. They may also be potentially useful sources of information for patients.
Some Royal Colleges, such as the Royal College of Surgeons, have Patient Liaison Groups and most of the Royal Colleges provide useful patient information on their websites. The Academy of Royal Medical Colleges website contains contact details and links to the medical Royal Colleges, which cover most medical specialties such as anaesthetics, radiology, psychiatry and general practice.
Second Opinions
In 2002, the BMA's Central Consultants and Specialists Committee (CCSC), together with its Medical Ethics Committee and General Practitioners Committee, produced guidance relating to patients requesting a second opinion. Although this guidance is primarily designed as advice for working consultants, patients may also find it useful.
The General Medical Council (GMC), the doctors' regulatory body, states in Good Medical Practice that, in providing medical care, 'doctors must respect the patient's right to seek a second opinion'.
References
- Department of Health. Building on the Best; Choice, Responsiveness and Equity in the NHS Norwich DH 2003; http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4075293.pdf
- Department of Health. The NHS Improvement Plan : Putting people at the heart of public service DH Norwich 2004; http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4084476
- Department of Health. Choice Matters: increasing choice improves patients' experiences London DH 2006;http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4135541&chk=Tcf9CM)
- Department of Health. Choice Matters: 2007–8 Putting patients in control. London DH 2007;http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_076331
- Where we are now. Choose and Book website (accessed 23 May 2008); http://www.connectingforhealth.nhs.uk/newsroom/latest/progress/choose
- NHS Direct. Patient Information Leaflet on Hospital Admission, NHS Direct. Available athttp://cks.library.nhs.uk/patient_information_leaflet/hospitals_admission/view_as_a_leaflet
- Which? Hospital Companion; Information and advice to help you in hospital London Which? 2008; http://www.which.co.uk/files/application/pdf/0710%20Hospital%20companion-445-122986.pdf