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Are you a patient access winner or loser?

The Department of Health wants to make it as hard as possible for GPs to maximise patient access income and GPs should be on their guard, says Dr John Couch

The Department of Health wants to make it as hard as possible for GPs to maximise patient access income and GPs should be on their guard, says Dr John Couch

This month has brought a new and controversial item to the practice payments calendar. This is the first year that the new patient access survey has been published.

When the amended system was announced more than 12 months ago it was clear that the Department of Health wanted to make it as difficult as possible to maximise access income. This was part of its 'grab money back from GPs' campaign, and recent survey results show just how successful it has been.

Old access payments were split into two elements. The first was 50 points in the quality framework based on a practice-issued annual survey. The second depended on fairly straightforward and achievable aims in a directed enhanced service. Together these were worth around £5,000 per GP, depending on list size.

The new scheme amalgamates both payments as a DES. Crucially there are three main differences.

First, the survey is sent direct to randomly chosen patients, bypassing GPs completely.

Second, the controversial wording of the survey is largely controlled by the Department of Health.

Third, the payment system sets tough thresholds and extremely high survey target results for maximum payment. In fact, two target maximums are 80% and the other two 90%. A private company would be surprised and delighted to get anywhere near this, and I doubt if any government in history has reached such heights of satisfaction.

The first important point for practices is to check payments. Most PCTs are new, and experience tells us that mistakes are possible. We should have received an initial payment of £0.69 per patient around 12 months ago based on a written access plan and agreement to participate in the survey. Check that this was received.

The second payment, of up to £1.37 per patient, is based on our survey result. My PCT did not include any calculations in its letter and I suspect this will be standard. Therefore, check each of the four components from the survey against the relevant table – 48-hour appointments, advance booking, telephone access and GP of choice.

This is in annexe 4 of the revisions to the GMS contract 2006/7 (Delivering investment in general practice), available on the BMA and NHS employers websites. Contact your PCT immediately if you disagree with the payment.

Next, study the results and decide what action points are necessary to improve results next time. Most of us will have lost income, some of us considerable amounts, as a result of this new system. You may take the view that the amount of effort involved is not worth the potential extra income. Unfortunately this is shortsighted. It will not be long before results such as this are used by PCTs to focus on practices it perceives as underperforming. Rather like an investigation by the taxman, this is something to be avoided at all costs.

Ominously, the original document states that the survey will be 'developed' further. This will include randomising the survey date and using the third available appointment as an extra marker. It is always possible that extended opening hours targets could be included – whether this will mean extra income remains to be seen.

Personally I look forward to the earliest possible political survey, aka the General Election, when I can extract retribution.

Dr John Couch is a GP in Ashford, Middlesex

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