How to choose your hospital or doctor
You’re entitled to pick your NHS care, but how do you do it, and how can it benefit you as a heart patient?
This is the era of informed choice. You no longer need to turn up at a restaurant and hope for the best: you can see photos of the food beforehand, browse the menu, and read recent reviews of the service and atmosphere. Similarly, in healthcare, there’s increasing emphasis on patient choice. You can read TripAdvisor-style reviews of your doctor, the cleanliness of your local hospital, and the standard of its facilities before deciding where you want to be cared for.
Legally, patients in England are entitled to choose their GP, hospital and clinical team (if you’re not in England, see box below).
Jane Mordue, Interim Chair of Healthwatch England, explains: “What it says in the NHS Constitution is that you have the right to choose your hospital and the consultant-led team that treats you. And if they can’t treat you within the timescale set out then they need to find another option for you. It is a legal right, and patients need to know that.”
You might want the nearest hospital, or you may be willing to travel to one with better ratings or more cases of the type of heart surgery you’re having.
How do you choose your hospital and clinical team?
When your GP says they’re referring you to an outpatient appointment at a hospital, they should ask if there’s a particular hospital and a certain clinical team that you would prefer.
Tony Smith, 56, from Cumbria, was diagnosed with coronary heart disease (CHD) in 2010, and had a total of four angioplasties at Northern General Hospital in Sheffield. But he was still experiencing angina and went back to see his GP, who recommended that he be referred to another cardiologist.
Tony told his GP that he was keen to choose his hospital and consultant. He looked at the Care Quality Commission (CQC) ratings, NHS Choices and at hospital websites, then chose Liverpool Heart and Chest Hospital. “It had won customer service awards five years on the run,” he says. “Another reason is that the cardiologist in Sheffield said to me that if I needed any more procedures done, Liverpool is probably one of the best places in the country to go. I checked the various cardiologists at the hospital to see how they had been rated on the websites".
Not all hospitals perform cardiac surgery or have a specialist cardiology department, so depending on where you live, you may need to travel beyond your nearest city, as Tony discovered. “The nearest cardiology unit to me at that time was in Middlesbrough, 150 miles away, or Liverpool,” he says.
“As well as the excellent ratings, I happened to have family in Liverpool anyway.”
If you research your care, it pays off
You can choose any organisation appointed by the NHS to provide clinically appropriate care for your condition. You can also choose your consultant, for example, if you’ve heard particularly good reviews for a certain heart surgeon at the hospital you’re going to.
How do you choose your GP?
You’re allowed to choose your GP surgery, too. This applies everywhere in the UK, although the practice can refuse if it has good reason, for example, if its list is full. You can also express a preference for a particular GP at your surgery, which your practice should try to comply with.
“Quite a few of our generation, the older generation, still think of the GP as knowing best,” says Tony. “The government and the NHS should be advertising the advantages of patient choice, or have posters in GP surgeries.”
Unfortunately, people aren’t always offered options. Only 40 per cent of patients were offered a choice of hospital or clinic, according to NHS England’s 2015 annual survey. But where patients were offered a choice, they were much more likely to be able to go to the hospital or clinic they want (91 per cent compared to only 41 per cent). If your GP doesn’t offer you a choice at the point of referral, don’t be afraid to speak up; do this when you’re first told you’ll be referred for a hospital appointment.
“That choice is a legal right,” Jane says, “and if you’re not offered that choice at the point of referral we would encourage patients to ask the doctor why, and if they continue to be refused they can contact their local clinical commissioning group [which is in charge of the health budget locally] or they can contact the ombudsman and go through the complaint system.”
If you didn’t realise you had a choice, you’re not alone – the survey found only 47 per cent of patients were aware of their right to choose. After his angioplasties at Northern General Hospital, Tony’s consultant at Liverpool Heart and Chest Hospital helped him manage his angina with medication. After two years, his condition had deteriorated and he had bypass surgery. He’s now doing well.
“I just happen to be someone who, if I know something’s wrong with me, I research it,” he says. “My brother was amazed that I went onto YouTube and watched a two-hour video that showed some of a heart bypass before I went for one.
“But if you research your care, it pays off. I’d definitely recommend choosing where you receive your care to other heart patients.”
Your rights around the UK
Northern Ireland: There’s only one hospital that carries out heart surgery, but you could choose to get treated elsewhere in the UK.
Wales: If you need hospital care, your GP will usually refer you to the cardiology team of your local health board. If required, they will refer you to a tertiary centre. For West Wales this is Swansea, for East Wales it is Cardiff, and for North Wales it is usually Liverpool. You are then allocated to a clinical team, but if you are not happy, ask for a second opinion.
Scotland: You would usually be treated in your home NHS Board area, but if you’d like to go elsewhere, you can discuss it with your GP or your lead clinician. If there are sound medical or logistical reasons to do so, your clinician can make a referral to another NHS Board’s area.