GPs are an "obstacle" to the government's proposals to eliminate excessive waiting from the NHS, according to the independent social-policy think-tank Civitas.
A Civitas report, Why are we waiting?, says the target of a maximum 18-week delay from referral to treatment (RTT), to be achieved by December 2008, is "an impossibility".
Civitas blames "the unwillingness of GPs to provide the necessary information to patients, out of a misplaced desire to protect the inefficient local healthcare system, including the nearest hospital."
The report has been written by James Gubb, Director of the Civitas Health Unit, and states: "As the government and the Department of Health (DH) are coming to realise, the only long-term solution to this is not targets, but choice and competition."
The report cites figures from September 2007 that show 57% of patients are now receiving treatment within the 18-week target.
"However," it states, "if the same trend were to continue then by December 2008 around 77%, or roughly three-quarters, of patients will be turned around in 18 weeks – not 90%, and certainly not 100%."
The report criticises "the still lacklustre numbers of patients actually offered a choice or using Choose and Book", citing figures showing just 45% of GP referrals are made using Choose and Book, which Civitas says "is necessary to access the benefits of competition".
The report concludes: "To its credit, the DH has – in the Operating Framework for the NHS 2007/08 – at least put in place the system for competition and patient choice to work.
"The challenge must now be down to PCTs and GPs to encourage choice and competition to ensure the window of opportunity that has been provided isn't missed.
"For the benefits of competition to be realised, and for waiting times to really accelerate downwards, the reluctance of commissioners to use independent providers at the expense of established NHS providers has to change - and fast."
Your comments: (Terms and conditions apply)
"I do not disagree with the concept of alternative providers, but we must be realistic about the underlying causes of waiting lists. The thrust of the article revolves around competition. We have patient choice, but this is controlled from the point of patient registration. The question "Do you reside in our current catchment area?" will pretty well determine whether a patient registers with a chosen practice in the first place. "Do you want to register with this practice?" might be more preferable to develop local competition. And so it goes on. Patients are able to exercise their preference under Choose and Book, but they are still at liberty to ask for the support and guidance of their GP in making this decision. Waiting lists are controlled by the hospitals. Patients will be prepared to wait longer for a procedure if they believe that the hospital that they have chosen will provide the best quality of care for them. Competition is fine and should be encouraged, but the recent vote of no confidence by GPs following the award of an APMS contract to a private provider is evidence of the potential problems that will arise due to the generation of competition within the NHS. Any current reluctance of commissioners to engage fully with the possibilities of PBC (whether this includes independent providers or not) has more to do with the lack of financial information, the paucity of data available and the prolonged process needs" – Name and address supplied