Harnessing Consumerism in Healthcare: A new way to advocate for your patients; a new route to influence health service policy. Dr. S. Arun-Castro MBBS AKC PG Dip Public Health

Background: Outside of the NHS, Jersey’s primary healthcare service operates in the private sector funded through user-fees and co-payments, whilst state-funded secondary care is free at the point of use . As an A&E FY2 doctor, I attended to many patients who avoided seeing GP’s and dentists due to concerns over costs. It occurred to me that the fee-for-service culture in primary care in Jersey could worsen inequalities, hinder access to preventative medicine and might place an unnecessary burden on the state through avoidable admissions and inappropriate service usage.

Policy Outcomes: Our findings have influenced the content of Jersey’s 2012 Health and Social Services Proposition (Bill), prior to its States’ Assembly debate. Specific terms in the proposition that relate to our work include the future legal requirement for Primary Care to establish “a charging model that incentivises care and cooperation, optimises access and equality… and offers value for money.”

Discussion: Evidence from a clinician-lead consumer advocacy survey has directly informed Jersey’s future health service policy. The current economic climate causes the public, policymakers and politicians to be more aware of value for money, cost effectiveness and service

sustainability. If the consumer is “king” in both economic and political terms, consumerism in healthcare presents an alternative route to influence health policy. Advice for Clinicians: Consider the opportunities that new structures present for advocacy and influence. E.g. HealthWatch England, CCGs & Clinical Senates

Results: 6,588 Jersey households participated in the survey. Preliminary analysis from 4026 respondents: ~1 in 5 households reported using A&E for a problem that was neither an accident nor an emergency. (18% ; 714/3925) A notable proportion of respondents report not attending Dentists (22%)

and GPs (6%) at all, due to costs of visits 75% of respondents felt that patients attending A&E with non-urgent

problems should pay a fee (2931/3919) >50% of respondents are not aware of a formal complaints procedure for

Primary Healthcare Responses highlight public anxieties regarding lacking price transparency related to costs of services offered by GPs, dentists and other primary healthcare professionals

Objectives: To examine whether clinician engagement in consumer advocacy offers an alternative to traditional methods of lobbying for policy change.

Method: In January 2012, I was selected to become a public member of the Jersey Consumer Council, an arms-length government funded consumer advocacy body. I advocated successfully for the Council to fund an Island-wide Survey exploring public opinions, experiences and behaviours related to healthcare payments. I helped establish a Primary Healthcare Users Group to address health related consumer concerns amongst patients, carers, NGO’s and providers. The group was used to pilot the study questionnaire. Our survey was distributed to 40,000 households. To encourage the widest engagement online versions and language translations were made available.

www.jerseyconsumercouncil.org