Norman A Weir
Background Patient empowerment and equality of access are central to the development of practice-based commissioning (PBC). The mechanism that is being used to facilitate this development is the Choose and Book system for referral to secondarycare. However, there is little evidence that the older patient (aged 75 years and over) wants the responsibility of making personal healthcare choices. Furthermore, the Choose and Book system may be inappropriate for this age group.Objective To explore with older patients the value of choice and the appropriate ways in which it can be expressed. Method Six focus groups were undertaken (n = 6 participants for each group). Four of these focus groups were conducted with older clients (two with male clients and two with female clients) and two were conducted with carers. Participants were selected from the practice patient database using a purposive sampling process.Results The study findings revolved around the following issues: ‘relevance of choice’, ‘barriers to choice’ and ‘mechanisms facilitating choice’. The key findings indicated that there was a greater interest in choice than was anticipated in the older age group. There was a unanimous agreement that choice should be made in partnership with a general practitioner (GP) acting as an advisor.While up-todate and appropriately presented information was seen as very important, more time was needed for itto be absorbed and for a ‘comfortable’ decision to be made.Conclusions The need for choice was fuelled by perceived variability in hospital service provision. The immediacy of decision making imposed by the Choose and Book system could impair independent choice options, and the time needed to overcomethis could create its own problems for GPs’ consultation schedules. While good information tools are needed to aid the choice process, they may not impact on patient satisfaction or anxiety levels. The creation of a voluntary patient support service mayprovide an ideal way forward.
