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by Anne Crandles
22 June 2009

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This muddled patient survey is holding practice cash to ransom

Scottish practices are “furious” over changes to the Patient Survey that have led to income cuts, says Edinburgh practice manager Anne Crandles. Below she expresses her personal view that this survey has incurred unwarranted penalties on some practices.

Among the changes to the Quality and Outcomes Framework (QOF) that came into effect this April was the removal of Patient Experience Indicators PE 2 and PE 6 and the introduction of a new national postal questionnaire (GP Access Survey – Indicators PE 7 and PE 8).

PE 7 measures the percentage of patients who had been able to book an appointment with an appropriate healthcare professional within two working days. PE 8 looks at the percentage of patients who could book an appointment with a GP more than two days in advance.

The questionnaire itself is a series of eight multiple-choice questions – two of which relate to PE 7 and two to PE 8. The remainder establish when the patient last contacted the practice, ethnicity, existing medical conditions and the impact of these conditions on the patient’s day-to-day activities.

Naturally, GPs and practice managers were furious! Previously secure practice income was now to be predicated on the perceptions of patients. No matter how good a service a practice provides, there are always disgruntled patients who, ironically, tend to be regular attendees and therefore all the more likely to be part of the sample! Practices found themselves – literally – at the mercy of their patients.

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Even allowing for benevolent patients, how were practices meant to achieve these indicators when so many had opted to provide Advanced Access appointment systems – almost eradicating forward booking? And had done so because they had been encouraged, and in some cases incentivised, to do so? The whole exercise appears to be a method of reducing GP payments, a way of helping the government to balance its books.

Year one results for Scottish practices were published last month (May 2009). Taken as a whole, these statistics reflect a positive outcome – PE 7 at 90% and PE 8 in excess of 75%. However, while the Scottish government reports a 50% return rate, the British Medical Association (BMA) is citing examples of practice return rates as low 0.28% [see story link below].

Not surprisingly, there are huge concerns regarding the robustness of the survey’s results. It would seem that on scratching beneath the surface of these “good news” percentages, practice managers’ initial fears were well founded. Results for practices in some instances make little logical sense.

How do you explain practices working in the same building, serving the same demographic group of patients with similar appointment systems obtaining completely polarised percentages? Or practices that operate open surgeries not achieving full marks for access to healthcare professionals? Or worse still, practices that provide a blend of same-day and advance booking, with previously high QOF points, being financially penalised?

For this is the true consequence of the GP Access Survey: significant drops in income for many practices with no tangible way of correcting this for future years. It has been suggested that huge in-house PR exercises will help – for example, displaying posters that tell patients that they can indeed have access to the primary healthcare team (GP in England) within 48 hours or book an appointment weeks in advance. At best, this is a sticking plaster but there seems very little else we can do to stem the flow (ie, cash!).

Originally, there were to be no appeal processes, but practices everywhere refused to sign off the results and appealed anyway – with support from local medical committees throughout the country. While health boards have expressed sympathy, the jury is still out as to whether or not these appeals will be upheld.

It will be interesting to see how England fairs at the end of this month.

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