With the possible exception of the Royal family, the National Health Service (NHS) is Britain’s best-known state institution.

The old NHS: loved but not always patient-friendly

Providing universal free healthcare to all UK residents, the state-run system is probably also its most fondly regarded public service.

But, for all the public affection, the NHS has sometimes lacked ‘user-friendliness’.

Advances in healthcare have not always been matched by flexibility to patients’ non-medical needs and changing lifestyles.

Hospital appointments system in need of reform

This has been especially true of the hospital appointments system.

Traditionally, this required the patient’s doctor, or General Practitioner (GP) to write to the hospital, which then allocated a date and time.

The process often took several weeks and patients tended to have little or no choice in an appointment date, even if it proved to be inconvenient.

Now patients can book appointments…

A new initiative should change all that, allowing patients for the first time to organise their appointments around their work and home lives.

Called ‘Choose and Book’, it means that from December 2005 all patients, or their GPs, will be able to book directly online, or via a telephone helpline.

…and choose where they’re treated

Perhaps more significantly, it also allows patients a choice of at least four hospitals.

Since April last year, Choose and Book has allowed those waiting more than six months for elective surgery the choice of transferring to another hospital.

NHS hospitals no longer the only option

The choice includes private hospitals and some non-hospital venues within the NHS’s so-called ‘primary care’ sector.

The latter are local, community-based services, such as GP practices and new one-stop, primary care centres, which include GP practice teams and specialised services, such as dentistry and optometry.

Primary care expands

The improvement in patient choice has come hand-in-hand with a rapid increase in the range of healthcare delivered via primary care services.

“The Government recognises that many hospital patients could be better treated at a local level,” says Dr Richard Lewis, a primary care expert at the King’s Fund, the leading independent health think-tank.

He adds; “There is also an awareness that the skills of GPs and specialist nurses are under-utilised.”

This recognition has led in recent years to GP practices providing minor surgery and other specific procedures, which were previously only available in hospitals.

Will standards be maintained?

According to the Department of Health, the number of minor medical procedures delivered in primary care settings will leap from 16,000 to 66,000 in 2004/05.

“Although some patients are suspicious that they’ll receive inferior care if they’re treated outside hospital, the medical outcomes tend to be just as good as hospital treatment,” says Dr Lewis.

Walk-in centres: a convenient new option

The NHS has also created 64 'walk-in centres' to deal with minor complaints. Some are based in existing hospital accident and emergency (A&E) departments and others within the community.

No appointment is necessary and most centres are open from early morning until late at night.

Since the first centre was opened in 2000, they have seen over six million patients - a daily average of 108 visits per centre.

Meeting employees needs

Twenty five more centres are currently under development, including seven at major rail terminals in London, Leeds, Manchester and Newcastle.

Targeted at commuters, these new centres will dispense with the need to make appointments with GPs (thereby losing valuable working daytime hours) and should therefore help to reduce health-related absenteeism.

NHS Direct: 24-hour access

Patients can also save time by calling NHS Direct, a 24-hour telephone helpline, or its Scottish equivalent, NHS24.

Each is staffed by nurses, who can assess callers’ symptoms, and advise on the most appropriate courses of action and sources of help.

Benefiting doctors and patients

Online versions of both services will allow patients to email their queries and access health information.

Designed to supplement (rather than replace) face-to-face consultations, each reduces the volume of unnecessary medical appointments and thus helps free up doctors to deal with those in greater need.