Summary Patient choice How patients choose and how providers respond

1. The NHS should continue to promote and offer patients a choice of hospital. Even if relatively few patients chose a non-local provider, our evidence found an intrinsic value in granting the ability to choose. 2. Patient feedback is likely to remain a significant driver of quality improvement. Choice appears to impact on quality indirectly, by creating a threat to providers that they might potentially lose patients. 3. Patient choice and competition operate to some extent in all study areas. Our findings challenged the belief that choice is relevant only in urban areas or for certain age, gender, ethnic or education groups, suggesting that present opportunities for choice are reasonably equitable. 4. It is important that regulation exists to maintain quality standards that ensure all providers meet minimum standards to protect patients, specifically for those who lack access to transport or in disadvantaged areas, which could impede their ability to access choice of provider 5. The costs and benefits of choice should be clearly quantified to convince GPs and providers of its value.