Andrew Lansley, the health secretary, defended his market-like reforms of the NHS on Wednesday against possible resistance from GPs, saying patients’ ability to choose where they were treated would help drive through the changes.

His remarks came in response to suggestions by Dr Hamish Meldrum, chairman of council of the British Medical Association, that by taking on the commissioning of care, family doctors would be able to “bypass, if not ignore” the government’s market philosophy.

If GPs took on the commissioning role, they would be able to “integrate care rather than fragment it”, Dr Meldrum said.

Some GPs are firmly opposed to the government’s use of competition and the private sector as a means of driving up performance in the NHS – something Mr Lansley is encouraging by completing the separation of the purchasing of care from its provision.

However, after speaking at the BMA’s annual meeting on Wednesday, Mr Lansley said patients would be able to choose where they were treated and GPs should support that.

Many GPs, he said, “are very clear about the nature of the competitive options to them for referral”,and he did not think they would want to depend on monopolistic providers of healthcare.

Mr Lansley also pointed out that the BMA’s opposition to the private sector in the NHS “is rather odd” given that “most GPs are independent, self-employed contractors who are profit-making and profit-distributing” while still considering themselves very much part of the NHS.

However, figures from his own department on Wednesday showed that there was a long way to go before patients routinely exercised choice within the NHS.

Four years after it was introduced, only 54 per cent of patients were aware that they had a choice of where to go for a first hospital appointment and only 49 per cent recalled being offered one by their GP. The figures have barely shifted upwards in a year. “The problem is that it is family doctors who initiate choice and a good number of GPs do not believe their patients want or need it,” Carol Propper, professor of economics at Imperial College and a leading researcher on the effects of competition within the NHS, said. “Mr Lansley is going to have to do much more to make patients aware of their rights.”

There was now, however, evidence that where hospitals were sufficiently close to offer competition, higher quality ones attracted more patients and drew patients from further away, she said.

The one encouraging statistic in the department’s survey, she said, was that six out of 10 patients who said they were offered a choice did not put having the care locally, near their work or home, as the most important factor in deciding where to go.

“That suggests they will take other factors, such as the quality of care, into account,” she said.

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