My first CASA working paper is now available. It is the result of a large amount of work I did for my upgrade from MPhil to PhD study at UCL. The topic is “Choice and the Composition of General Practice Patient Registers“. The abstract is as follows:

Choice of general practice (GP) in the National Health Service (NHS), the UKs universal healthcare service, is a core element in the current trajectory of NHS policy. This paper uses an accessibilitybased approach to investigate the pattern of patient choice that exists for GPs in the London Borough of Southwark. Using a spatial model of GP accessibility it is shown that particular population groups make non-accessibility based decisions when choosing a GP. These patterns are assessed by considering differences in the composition of GP patient registers between the current patient register, and a modelled patient register configured for optimal access to GPs. The patient population is classified in two ways for the purpose of this analysis: by geodemographic group, and by ethnicity. The paper considers choice in healthcare for intra-urban areas, focusing on the role of accessibility and equity.

The paper is accessible here.

I am growing very interested in how the NHS actually facilitate choice within the primary care system. This post investigates the apparent asymmetry between choosing a hospital and choosing a GP using NHS Choices, the NHS’s online health portal. Figure 1 is a screen capture of the results list presented when searching for a GP, figure 2 is the equivalent results for a hospital search.

The GP search creates a basic proximity ranking of the potential GPs available from an individual’s postcode, as per the example of a GP search shown in Figure 1. Search results cannot be manipulated in any other ways, meaning that non-accessibility based criteria which prospective patients might wish to fulfil cannot be met. Options related to choice are not-present at the start (these could include patient list size, number of doctors, services offered etc), although some of this information is available when you ‘drill-down’ by selecting a specific GP.

When searching for hospitals it is possible to search not only by postcode but also by specialty. When search results are presented they are given with an indicator of “Quality of Service” from the NHS Annual Health Check, which measures Hospital performance. Further, the results also include the standardised mortality ratio, and some wiki-style reviews of the hospital. All this information exists for Hospitals without drilling down, and when you do there are further measures to help patients choose a suitable hospital.

GPs, unlike hospitals, have very limited quality criteria confined to opening and closing times. The NHS seems to limit the possibility of defining a GP as good or bad through use of waiting times, understandable prevalence data and such. This attitude in particular seems contra to the choice agenda being pushed. However GPs (surgeries) are a partnership between the public NHS trust and the private General Practioner(s) (GPs – doctors) that run them so such a black and white classification may be difficult for the NHS to achieve politically, despite the likely patient benefit.

Figure 1: NHS Choices, GP search results for a postcode in North London (http://www.nhs.uk)

Figure 2: NHS Choices, Hospital search results for a postcode in North London (http://www.nhs.uk)