The first ever NHS constitution, enshrining the principles and values of the 60 year old service, will take effect from later this year.
The constitution, thought to be the first of its kind in the world, pulls together existing rights, responsibilities, and pledges in one document. It includes what the government says is a new right—the right for patients to make choices about their NHS care, including choosing their general practice and expressing a preference for using a particular doctor.
The constitution will be reviewed every 10 years and will be accompanied by a handbook that sets out current guidance. This will be revised every three years.
The draft constitution follows year long discussions with staff, patients, and the public. It reaffirms that the NHS is a comprehensive service; that access should be based on clinical need, not an individual’s ability to pay; and, with a few exceptions, that the NHS should be free of charge.
Other rights include the right to drugs and treatment recommended by the National Institute for Health and Clinical Excellence, if approved by the patient’s doctor, and “to expect local decisions on funding of other drugs and treatments to be made rationally following proper consideration of the evidence.”
However, the health secretary, Alan Johnson, accepted that the right to choose a GP might be theoretical in some circumstances because “some lists are full.”
Several commentators also thought that the constitution would make little difference on this point.
A spokesman for the BMA said, “At present a patient has a free choice of GP, but clearly there are practical considerations if GPs were to take patients from outside their catchment area. There is a formal procedure for a GP wishing to close his or her list, which has been in place for a while. On the face of it, the constitution would not appear to change present circumstances.”
Iona Heath, a north London GP and chairwoman of the international committee of the Royal College of General Practitioners, expressed scepticism about the constitution. She said, “The draft constitution looks like another example of the emperor’s new clothes—it’s simply an expanded version of the old patients’ charter. I can’t see anything genuinely new in it at all.
“In particular, patients have always been able to choose their GP. In fact now their choice is less, because they can only register with a practice and not with a named doctor.
“And clearly you cannot choose to see a particular doctor if they are sick or on holiday or are already trying to look after more patients than they can safely manage.”
There will also be rights to be treated with dignity and respect and to complaint and redress, allowing the public to get a swift response if they are unhappy with their health care.
The constitution contains a number of pledges in which the NHS promises to “strive” to achieve a range of objectives, including providing services in a safe and clean environment, ensuring smooth transition between services, and sharing any letters sent to clinicians about a patient’s care.
Rights are to some extent balanced by responsibilities, including the responsibility to “make a significant contribution to your own and your family’s good health and take some personal responsibility for it.”
Staff also have rights and responsibilities enshrined in the constitution. These include having a good working environment; fair pay and contract framework; and safe working conditions free from harassment, bullying, and violence. Responsibilities include not discriminating against patients or staff, protecting confidentiality, and being honest and truthful when applying for a job.
Steve Field, president of the Royal College of General Practitioners, welcomed the constitution. “It is something to which all GPs, their practice teams, and NHS staff can commit to and have confidence in to improve standards and care for all our patients.”
All the rights and pledges in the draft constitution are underpinned by existing law or policy except the new right to choice, which will be put into law separately. All NHS organisations will have a legal duty to take account of the constitution. A 14 week consultation began on 30 June, and a final version is to be released by the end of the year.
Cite this as: BMJ 2008;337:a640