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Practices struggling with patient DES

22 August 2011

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GP practices are struggling with the new patient participation directed enhanced service (DES), a Pulse report has revealed.

Practice managers contacted by the GP publication said that they were confused over aspects of the DES and that the money received was not sufficient for the time and effort it required.

The patient participation DES, launched in April 2011, is a two-year DES that applies to practices in England.

It was introduced to ensure that patients are actively involved in decisions about the range and quality of services provided by their practice.

Practices demonstrating they are actively engaging with representative cross-sections of patients – whether through patient participation groups (PPGs) or ‘virtual PPGs’ (seeking patient feedback via email groups) – can receive an overall payment of £1.10 per registered patient.

However, four months after the introduction of the DES, Sheila McLean, a practice manager in Essex, told Pulse of a “sense of total despondency” over some aspects of it at a meeting with 30 other practice managers.

She said: “It involves massive amounts of paperwork – you have to show evidence that you’ve tried to do everything you could to recruit patients from all elements of your practice population.

“You do all of this and you end up with £1.10 per patient, which is nothing compared to the time and resources you put into all of this.”

She also spoke of “confusion” about survey requirements around the DES. “We don’t know how many surveys to do,” she told Pulse.

“Someone at the PCT suggested we do about 5% of our patient population, another suggestion was that we do 100 surveys. It feels a bit like we’re asking how long is a piece of string?”

A spokesperson for the NHS Employers organisation said: “We believe the financial recompense is set at a level that is appropriate and this was agreed through negotiation with the GPs’ Committee (GPC).

“The DES is designed to be manageable and ensure that patients are involved in decisions about the range and quality of services provided and, over time, commissioned by their practice.

“There is considerable support available to GPs to help them fulfil the patient participation DES through the jointly published guidance, supporting FAQs and referenced web links.

“If GPs do raise specific suggestions about information that could be produced nationally to help them, we would be happy to discuss this further with the GPC.”

Your comments (terms and conditions apply):

“Our previous group which had been very successfully running for ten years had disbanded when ill health claimed some of the influential members and we were in the process of re-engaging with the patients to develop another group before the DES was announced. The partners each nominated patients from all backgrounds and minority groups. Not all invited agreed to become part of the group, which highlights how difficult it is to get a group that is representative of the patient base. It is essential to set the ground rules at the beginning. The forum is not for personal issues, and that membership of the group holds no special favours over other patients. There are plenty of resources on the patient participation website to support practices in setting groups up. The biggest hurdle for those that want to do this purely to meet the DES is very difficult because of the cross section of patients that are interesting in being in the group. Our new group is forming very well and have just produced the practices’ first newsletter – the elections of their committee are happening as I write. We asked the group to ensure that they reach out to those patients not interested in being involved with committee – they are doing this by organising an educational event and advertising this to all patients” – Christine Earwaker, Surrey

“Only worthwhile if you are in a large Practice and already have a PPG, I suspect” – Patrick Jordan, East Manchester

“I think this is being made out to be a larger piece of work than it actually is. It isn’t really much more than we we’re doing before the practice survey was taken out of QOF and replaced with the national survey. I expect the national survey will disappear in the next couple of years as it is so costly to run. You don’t have to use the QPAQ survey either you make one up specific to your practice needs. If you can’t get a diverse membership in your patient group, all you need to do is prove you tried. The most complicated thing you have to do is upload the report of the survey onto a practice website – i am no IT expert, in fact we haven’t got an IT expert at our surgery, but i believe that simple websites are very easy to create. I am also informed that the report can be uploaded to the NHS Choices website too. We have recently recruited a new member to our group who is happy to receive emails from our virtual members. It is important that the group members take ownership of this piece of work and then use Practice Managers for guidance” – Lisa Benton, Worcestershire

“Although we have an understanding of this DES, there are aspects with regard to the number of surveys etc that should have been made much clearer. It is a relatively simple task to undertake but we all need to be ‘singing from the same book'” – Angela Alderson, Darlington

“Lots of time and effort put into setting up patient group – we had tried 3 times before but with PCT backing this was going to be all singing and dancing – one person turned up and thankfully as I had a PCT facilitator present – sang our praises. I will give it one nmore go and then insist that I get paid because we have demonstrably done the work – I can even give pics of posters in the community in evidence! Patients have a right to choose not to participate too and in this brave new world of patient choice the govt have to be prepared to accept that. I still think many of those who do not carry their secondary care referrals through do not feel up to making the choice and at heart want someone else to do it for them – though I admit I work in a very deprived area where many just seem to expect someone else to do things for them” – Name and address withheld

“We have decided not to take part in this DES. As a small practice, the renumeration (per patient) is not worth the work involved. The amount of time and resources and work required from us is the same as for larger practices who would receive greater renumeration. It is just not worth it” – Lyn Lynn, Hertfordshire

“This DES is yet another example of bureaucracy that impacts disproportionately on small practices. The amount of work is broadly the same whether you have 1,500 or 40,000 patients, yet the payments are per patient. We have had a PPG for the last ten years. The patients’ representatives (almost all elected councillors)make all the decisions about how the group is run. All totally democratic. Apparently this is not good enough for the PC, minorities-obsessed Guardianistas at the DOH. I’m not sure how the group will react to being told they are not good enough in the eyes of the powers that be” – Clive West, Yorkshire

“We have really struggled with the Patient DES. Despite a big poster/leaflet campaign and sending individual invitations to 600 patients, we have 10 patients signed up to a virtual PPG. The time and effort spent on this has far outweighed the response back from our patient population” – Liz Reynolds, Surrey

“Do you know what, as a patient on a GP register i am totally fed up with taking phone calls asking me to come to have my blood pressure checked, to have my blood taken, to have an NHS check to take part in this or that. Leave me alone. This is what i want from MY GP plain and simple; for him to be there when i need an appoint. instead of being off on some ‘training’, or even worse off taking part in the organisation the ‘new consortia’. If i am ill i want a prompt diagnosis or referral not a shut up script, in other words i want a full time hands on GP whom i will continue to visit only when i feel i need to instead of being made to feel that i am just a money making machine for him/her. And by the way do not ask me to come in for a flu jab either” – Marie, Lancs

“There is no doubt that the DES entails a lot of work but if we look at the future of General Practice when Consortia become statutory bodies we must appreciate that the Patient Voice will need to be heard. The Patient role, in the new era particularly, will be a pivotal role in the organisational structure and we must start to realise that at Practice level we can work with our Patients to help their development into ambassadors for primary care services. A group of Practices came together in our locality to ensure that all Practices were fully aware of what the Patient DES entails and, it was clear at the beginning, that not all were fully informed. However, I believe that all went away with a clearer understanding of what was required albeit a big challenge to undertake, especially for those practices that had not had any patient involvement to date” – Julie Jackson, Essex

“I too have beaten myself up over the despondency shown by patients to engage, I have tried everything from advertising locally to handing out slips of paper to new and old patients alike. This has been going on for over 2 months now and I have managed to recruit the grand total of 16 patients from a population of 5500. Something tells me I have spent the money twice over already. And what is the real patient benefit anyway?” – David Shaw, Kent

“The DES has not been thought out correctly, is very time consuming and the lateness of information coming through has created yet another pressure general practice can do without. Perhaps they hope we will fail and save the department money?” – M Robinson, Yorkshire