The “choice gap”: do patients get the choices they want from GP care?

Primary care delivers 90% of the interactions between the NHS and the public. Ensuring appointments in general practice work for patients will therefore go a long way to improving people’s experiences and perceptions of the NHS. 

What choices do patients want when they book GP appointments? And are they getting these choices? Through nationally representative polling and semi-structured interviews, Healthwatch England's research aims to answer these questions. In their feedback, the public have been clear that choice matters, and delivering patient choice is key to empowering people to make decisions about their own care. 

We have found a choice gap in general practice, with people not always getting the choices they want. Older people, women, disabled people, and those unable to work due to health issues are all more likely to be affected by this gap. We hope our findings and recommendations lead to more people getting the choices they want and need.

Key findings:

People do not always get the choices they have a right to. Under a third (30%) of people are always given a choice of booking method for appointments, and around one in six (16%) are never given this option. This suggests that people aren’t always given or can’t easily find their available choices when booking appointments, and/or the proportion of directly bookable appointments is low.

People want more choice when booking GP appointments. Organising appointments to work around their lives matters to people, with time of appointment, choice of booking method, appointment type (face-to-face versus remote), and health professional the most desired choices.

Patients face a choice gap. In all the choice options we offered respondents, we found a gap between how often people wanted particular choices and how often they were offered them. For example, there is a 19% gap for choice about when an appointment takes place: 68% told us they want this choice  always or most of the time when booking an appointment, but only 49% told us they get this choice always or most of the time. 

The choice gap affects some groups more than others. The choice gap is generally larger for older people, women, and those unable to work due to health issues or disability. 

People often must ask for certain choices, rather than being offered them. Nearly half (48%) of those who got a choice of a named healthcare professional told us they had to ask for the choice, compared to 40% who got the choice without asking. The same is true for requesting a longer appointment, which 47% got by asking for it, while 37% got it without having to ask.