NHS reforms 'too slow'

While they have shown some encouraging results, there is still a long way to go before benefits to patients are fully realised, it said.

The study by the Audit Commission and Healthcare Commission found that implementation of measures to move care closer to home and increase patient choice have been slower than expected.

Since April, patients have been able to choose from any NHS hospital in England or private provider that uses NHS money for their elective care.

The study noted that in 2006/07 only 11% of primary care trusts were using the Choose and Book system for booking appointments despite a goal of 90% utilisation. Another 31% were underperforming against this target while 58% had outright failed to meet it.

Such evidence suggests "that the challenge of persuading GPs to adopt the new system has been greater than anticipated".

The report also found that patients did not have enough information to comfortably decide where they wish to be treated.

"The pace of implementation of the choice policy is lower than expected and challenging," it said. "Patients continue to be offered choice without having the information that they feel they need to be able to make a decision."

One of the Government's key aims is to move care out of hospitals and into the community. But the report said this did not appear to be happening on the "scale that was envisaged", with the numbers of staff in primary care increasing at a slower rate than in hospitals. The study also called for better collection of data on performance and activity in primary care.

The Government stated that, by 2004, consultants who had previously only worked in hospitals would be providing four million outpatient appointments in the community. However, no data has been collected to measure this, a situation that needs to be "urgently" addressed, the study said.