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Questions raised by tale of two surveys

28 August 2009

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I’m writing this the day after my return from a lovely week away in Croatia (most definitely recommended). Fully refreshed and raring to go, I arrived at the surgery car park to be greeted by the sight of two smashed windows; twin victims of a disgruntled patient equipped with a sledgehammer.

Great, I thought, but at least it can only get better. Two complaints later and then needing to call back a list of people who want to groan at me, I soon forget that I have ever been away – and it’s not even lunchtime.

I look at the to-do list I left for myself before I went on leave. Now I’m the one groaning. The Quality and Outcomes Framework (QOF) visit – is the report back? Despite QOF having been around for some time now, we had only our first 5% visit in July. I dealt with the organisational side of things and I think I got off relatively lightly. Our lead QOF GP and our QOF co-ordinator had to endure six hours of clinical system scrutiny. Although the visiting team from the primary care trust (PCT) were very nice, it was obvious we hadn’t got everything “just so”.

Needless to say, we have a few tweaks to make to our systems. However, the report is not back, having been delayed until September – at which point we will only be halfway through the financial year. Not much work to do there then! To help you prepare for a similar predicament, you may find Steve Williams’ article useful, in which he looks at practice’s requirements for QOF visits.

Access conundrum
Then there is the GP Patient Survey – see our special report. Were you one of the practices that appealed over payment for PE7 or PE8? We certainly were. Don’t get me wrong, our access isn’t perfect – we know we need to work on it and are currently undertaking a review. However, the number of respondents to the survey was pitiful, and makes the whole process meaningless.

Having complied with every access project that has come our way – eg, changing our systems to ensure we could accommodate 48-hour access – we feel justly aggrieved that we have been penalised and have lost money, which will have a detrimental effect on those services we should be improving! We haven’t received a response to the appeal yet either.

Still on my soapbox and prompted by the MiP premises survey results, I feel compelled to mention the association between access and premises.

Like many of you, we are working out of converted houses – three of them to be exact – which we have tweaked and extended several times over the years. There is nothing more to be done. We are desperately trying to gain approval for new premises.

The state and size of our premises places a severe constraint on our accessibility. We are definitely not compliant with the Disability Discrimination Act, and waste so much time waiting around for room availability at times when one of our less able patients can’t get up the stairs, nipping in when another doctor nips out – not really the way we want to practise medicine in the 21st century.

However, it is a brave primary care trust executive that approves new premises development, as he/she now has only one pot of money to resource all of the necessary services. Gone are the days when premises funding was dealt with separately. Dr Prit Buttar of the British Medical Assocation (see premises survey report) is right when he states that premises funding has been severely neglected within the current system.

However, without decent premises, how can we improve access, how can we engage in practice-based commissioning and how can we develop services? I would ask chief executives to be brave and stick their necks out, for without modern healthcare facilities how can we offer patients the services they deserve?

Finally, there are two more MiP Events taking place soon: London on 2 September and Birmingham on 6 October. It would be lovely to see you there. For now, enjoy the Autumn issue.