Políticas contables significativas (continúa) i) Activos intangibles

5.49 In general, the OFT's research suggests that PH patients, GPs and PMI providers would value greater information on the clinical performance and quality of care offered by consultants.

5.50 For patients, a great deal of reliance is placed on GPs as a result of a lack of access to standardised and comparable information, 153 _{and that}

patients, therefore, tend to choose a consultant who is suggested by their GP. 154

5.51 GPs tend to refer patients to named consultants rather than providing an 'open referral' to a PH facility.155 _{The main factor GPs tend to consider}

when making a referral is the consultant's reputation. 156

case that a surgeon, at the time of booking the procedure, may not know the identity of the specific consultant. For instance, see FIPO's template consultant booking letter (available at:

www.fipo.org/resources/index.htm) which allows room for this possibility via its wording

152 _{OFT GP survey, pages 34-5}

153 _{The OFT patient interviews, page 47, conclusions 2, 6 and 9. See also, Theme 6 (pages 41-}

46)

154 _{OFT GP survey, at pages 24-25}

155 _{Evidence submitted to the OFT by PMI providers typically identified around nine out of ten GP}

5.52 For GPs, as was the case with information for PH facilities, individual sources of information for consultants tended to provide only 'some' useful (as opposed to 'significant' amounts of information), and most GPs indicated that only 'some' or even 'none' of their information needs were presently being met as regards key consultant performance

measures.157

5.53 GPs use their knowledge from relationships with specific consultants, feedback from patients, information from marketing materials provided by PH facilities and informal social contacts with health professionals to help them advise patients as to treatment options.158 _{Given the lack of}

access to standardised, comparable information on the clinical

performance of consultants, information obtained via word of mouth and past patient experience 159 _{may be particularly influential and relied upon}

by GPs when recommending a consultant. 160

5.54 Although this 'soft' intelligence may provide information to aid choices locally and is to be valued, it will not assist patients who, if provided with relevant information, may want to be treated byconsultants other than those with whom the GP is familiar. These factors may be

especially the case where a GP (such as a locum) has little connection

156 _{OFT GP survey, at page 22}

157 _{OFT GP survey, page 35}

158 _{This dynamic is found in The King's Fund: An Anatomy of GP Referrals, 2007, and can also}

be detected via consultants' own preference for informal networking with doctors when seeking to build their private practice (OFT consultant survey, pages 45-6)

159 _{OFT patient interviews, at page 27, where a patient had reported that: '...the preferred}

consultant (from a list of three) was someone the GP had referred a lot of patients to and who had received positive feedback from them.'

160 _{OFT GP survey, at pages 32 and 55-6, shows that 72 per cent of GPs used informal social}

contacts with health professionals as a source of information about privately practising

consultants (the second most common source after information sent by PH facilities), and that the most common method for consultants to increase their private work was via informal networking with doctors (66 per cent), whilst over a quarter also mentioned visiting/contacting GPs.

with the local area and is therefore not privy to the types of soft, local information typically utilised.

5.55 Over-reliance on soft intelligence or informal views can also raise the risk of entrenched referral patterns or biases which dampen demand-side competition in PH. It may also inhibit efforts by the GP to explain to the patient the basis for their recommendation of a particular consultant or to elaborate to a patient a meaningful choice of consultants.161 _{Such a}

reliance on soft intelligence may also not result in a comprehensive information platform for the making of a fully considered, informed choice on the part of the patient.

5.56 The OFT considers that the exercise of an informed choice in this

context is especially important given recent research evidence to suggest that clinical performance may vary substantially between different

consultants/consultant teams. 162

5.57 The OFT has heard from a number of stakeholders outlining how an increased emphasis on the provision of comparable clinical information in some specialities, such as cardiothoracic surgery, has enabled a step change in quality by providing a measure by which consultants can benchmark their performance against others and a means by which patients can make informed choices and thereby drive competition between consultants.

5.58 The OFT considers that the current lack of access to standardised, comparable information on the quality or clinical performance of consultants weakens the ability of patients and GPs to stimulate

161 _{OFT patient interviews, at page 27, reported that: 'Where GPs did make recommendations,}

clear reasoning was not always provided and participants did not always know why a particular Consultant or hospital had been recommended. Where lack of information caused the most confusion was when the GP provided a number of choices, but gave no information about what differentiated one Consultant from the other. In such a situation, participants did not see a benefit in being provided a choice'.

162 _{A recent study indicating such variability is: 'Variation in reoperation after colorectal surgery}

in England as an indicator of surgical performance: retrospective analysis of Hospital Episode Statistics', Burns et al, BMJ 2011; 343:d4836

competition between consultants and drive performance standards and quality overall.

5.59 In addition, the OFT considers that, in line with the ongoing patient choice agenda, 163 _{access to more standardised, comparable information}

on consultants would be beneficial to inform discussions between GPs and their patients. This is especially the case given that forty-one per cent of GPs do not see it as their role to simply mandate their patients towards a particular consultant. 164

5.60 The OFT believes that variability in the use of fee estimates by

consultants may also harm PMI funded patients by preventing them from obtaining a prior warning of a potential shortfall from their PMI provider and the option to find an alternative consultant who charges within PMI fee schedules.

5.61 Additionally, in relation to the possibility that a patient might be willing to agree a top-up payment with a consultant prior to treatment, without greater information regarding the quality of care being offered by the consultant (either in that specific treatment episode or historically), a PMI funded patient has little ability to establish whether a consultant's higher fee represents higher quality of care and is thus a price worth paying over and above the limits permitted under the patient's PMI fee schedule (further issues relating to PMI fee schedules are considered in the following section).

The information role of PMI providers