Medical DevicesFlawed Patient Survey Will See Millions In Funding Lost To General Practice, Says BMA, UK
Despite results which show patients are very happy with access to their GP, this year"s patient survey will result in millions of pounds being lost to general practice, potentially damaging attempts to improve GP access, the BMA said yesterday (Tuesday 30 June 2009). This year"s patient access survey results published today found nine in ten (91%) of patients were satisfied with the care they received at their surgery, nearly 17 out of 20 (84%) could get an appointment within 48 hours, and three quarters (76%) were able to book an advanced appointment. It is not possible to compare this year"s results with previous years" because the wording of the questions has changed.
However, the results for individual practices show that a significant proportion have lost funding unfairly. The BMA has repeatedly warned that the Patient Experience Survey is fundamentally flawed. Dr Laurence Buckman, Chairman of the BMA"s GPs Committee, said:
"We are pleased that the vast majority of patients are satisfied with the service they receive, however the headline figures hide a gross unfairness - thousands of surgeries losing funding based on the answers of a tiny proportion of their practice"s population. In some cases the answers of fewer than a couple of dozen patients will have led to a practice losing thousands of pounds in res. Ironically this will make it harder for these surgeries to then improve their access, which is not going to benefit patients."
For example, one practice in rural Lancashire stands to lose ÷£10,000. It has a list size of 14,000. Less than 1% of its patients answered the questions about 48 hour and advanced access. Over nine in ten (93%) of their patients were happy with the practice"s 48 hour access and six in ten (61%) with their advanced access. Dr David Wrigley is a partner at the practice in Carnforth which also has three other branches in surrounding villages. He said:
"Our surgery allocates patients to a specific GP1 because we find that"s what most of our patients want, particularly those with long term conditions. But if patients can"t get an appointment with me because I"m on leave or at a different branch surgery they might perceive it"s not good access even though they are always offered an appointment with another GP. The survey doesn"t accommodate for this sort of thing and so by trying to provide more personal continuity of care we"ve ended up being penalised."
Other practices have lost less, but the small number of responses has distorted their results. The BMA is aware of one practice with a list size of 13,000 where just 41 patients answered the question about advanced access. Thirty three said they were happy with the practice"s access meaning the practice satisfaction rate was 80%. If just four more patients had answered positively the practice would have got top marks. Because this survey is now part of the Quality and Outcomes Framework (QOF) the practice has lost over ÷£3,0002.
Dr Buckman said:
"We want patient feedback, and surveys can be a good way of getting this. Sadly this year the government scrapped the more meaningful practice-based survey, they didn"t listen to our concerns and instead brought in this survey which is a mess. It is this survey which should be scrapped as it"s not fit for purpose. The questions can be misinterpreted, the survey is very long3 and too complicated. In affected practices, patients could end up falsely believing that the overall quality of the practice has dropped because it has lost QOF points and that might not be the case at all.
"It"s a waste of ÷£8 million which could be better invested elsewhere, for example by increasing the number of Patient Participation Groups as they encourage local practice-based patient involvement meaning patients would be able to have genuine involvement in determining how their GP services are run."
1 The introduction of the new GP contract in 2004 meant that patients no longer registered with an individual doctor but with a practice.
2 This is the first time the Patient Experience Survey has been included in the Quality and Outcomes Framework (QOF), before then it was a Directed Enhanced Service, an "optional" extra. QOF awards up to forty per cent of practice funding. It is made up of 1000 points and each point is worth approximately ÷£128 to the average practice. The survey accounts for 58.5 points. There has been a year on year increase in average points awarded to GP surgeries since the QOF was introduced in 2004 and last year practices in England achieved an average of 968 points. In this example the practice has lost 11 QOF points which equates to just over ÷£3,000.
3 The survey in England contains 49 questions. Two questions determine practice funding (PE 7 and PE 8).
On Wednesday 1 July doctors at the BMA"s annual meeting in Liverpool will debate the patient survey. The wording of the motion is as follows:
That this Meeting supports meaningful, and facilitative patient feedback on NHS services but deplores:
ii) the National Patient Survey of GPs which is unfit for purpose and represents a politically motivated scrutiny of general practice unparalleled in any other part of the public sector.
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