Cookie policy notice

By continuing to use this site you agree to our cookies policy below:
Since 26 May 2011, the law now states that cookies on websites can ony be used with your specific consent. Cookies allow us to ensure that you enjoy the best browsing experience.

This site is intended for health professionals only

At the heart of general practice since 1960

Cock-up or conspiracy? How the access survey cost GPs £35m

Pulse investigates how eight out of 10 practices lost out - with the poorest practices the worst hit

By The Pulse news team

Pulse investigates how eight out of 10 practices lost out - with the poorest practices the worst hit

When the Government decided to spend £8m finding out what patients thought of access they failed to mention that general practice would lose almost £35m as a result.

The views of patients ­ and in some cases a tiny handful of them ­ have certainly had a massive impact on GP practices, thanks to data from the 49-question postal survey, delivered to ministers by Ipsos MORI.

And the losses appear to have hit practices in the most deprived areas particularly hard ­ the very practices the Government supposedly wants to improve.

But how did it come to this? And were the losses a statistical cock-up or a calculated attempt by the government to claw back cash from GPs?

The statistical validity of the survey has certainly been called into question by many who will lose out, especially from practices where the survey response rate was pitifully low. And our analysis suggests some of the losses are due to this. But there is also a suggestion that the GPC-negotiated tougher thresholds may be the cause of the bulk.

Rates of deprivation

What our investigation proves beyond doubt is the financial impact the survey has had on practices throughout the country ­ almost £27m lost in England plus £8m in Scotland, Northern Ireland and Wales (see box).

And our investigation shows those in the most deprived areas are losing 25% more on average than those in the least deprived areas.

Practices in the most affluent areas lost an average of £2,945 per practice, compared with those in the most deprived, with an average loss of £3,694.

To date, more than 3,000 practices are thought to have lodged appeals over their survey results.

Dr Clarissa Fabre, a GP in Uckfield, East Sussex, whose practice is appealing its results after discovering they lost £4,000, claims the survey has backfired.

'It's appalling,' she says. 'They shouldn't be basing our funding on it.

That's £4,000 less to spend on the patients. The Government is trying to claw back money.

'It's crazy,' is the verdict of Dr John Doyle, a GP in Redhill, Surrey. 'Some people have lost very significant amounts of money. For some practices it can be an important part of their income.

'This is happening at a time when the Government is supposed to be increasing access to patients ­ how are they going to do it by taking money away from practices?'

The problem facing GPs appealing against their results is actually trying to prove the survey is statistically unfair.

So far just one PCT has publicly announced it has plans to pay compensation to a practice that has lost out.

NHS Haringey, the PCT in question, says: 'One discretion-ary payment of £782 has been made to a Haringey practice.' This is hardly likely to comfort the droves of GP practices that are appealing across the UK, which have lost up to £25,000 in some cases.

But, after an initial wobble, the Government appears to have toughened its line on such potential payouts.

Speaking to Pulse, new health minister Mike O¹Brien says he is sure the survey is 'statistically robust', pointing out that overall response rates were better than last year.

Much controversy has centred around the agreed confidence levels used by Ipsos MORI.

MORI was told by ministers to design the survey to have a 7% confidence interval ­ with accordingly large sample sizes.

Many practices have found their results to the key questions on access have been based on sample sizes not meeting these criteria.

In fact, there appears to be a clear association between deprivation and sample size. In the least deprived areas, an average of two practices per PCT had results outside the confidence intervals for PE7, compared with five in the most deprived areas.

But our analysis suggests that, overall, only just over £4m of the losses can be directly linked to tiny response rates to the survey. Another £9.4m (35%) of the losses were from practices that lay outside those confidence intervals.

Explaining losses

So how can the rest of this loss be explained? The biggest factor could turn out to be political rather than statistical. GP negotiators signed up to a deal allowing the recycling of 58.5 QOF points to incentivise access, which included much tougher thresholds in the survey for questions PE7 and PE8.

As part of negotiations over changes to the QOF, the previous Patient Choice Survey was swallowed by the new Ipsos MORI poll, now conducted quarterly and rewarding practices entirely through the QOF rather than a DES.

Thresholds for the two payment questions, previously 50-90% for PE7 and 40-90% for PE8, were raised to 70-90% and 60-90% respectively.

'The key fundamental area is the way that the thresholds have been applied,' admits Dr Richard Vautrey, deputy chair of the GPC.

But Dr Vautrey says negotiators were left with little choice but to comply during the volatile climate of last year's contract negotiations, claiming the Government was hell-bent on clawing-back money from practices.

'There was really nothing that we were able to do to prevent the Government from doing this,' he says.

'The expectation was that the thresholds would be higher than the previous access DES thresholds, and we did our best to try to limit the rise of the thresholds as part of our discussion, but the Government was very clear on what it expected to happen and what it would accept.

'We said at the time that this wasn't just about how the survey was carried out, it was actually a determined effort to reduce money to practices through the QOF. That's what's proved to be the case. We need to recognise it for what it was, a strategy by the Department of Health to reduce income going into practices.'

The GPC is now calling for the survey to be scrapped, a popular idea among grassroots GPs, many of whom are fuming.

'The patient survey should not be part of QOF at all. It is useless,' says Dr Robert Addlestone, a GP in Leeds whose practice stands to lose between £6,000 and £7,000.

'It is definitely worse this year. It has affected our QOF figures, and is going to put more pressure on everybody to try to gain the maximum amount we can from QOF in other areas, which is already very difficult.'

The patient survey has changed radically since it was introduced in 2006 by the health secretary at the time, Patricia Hewitt.

It has gone from part of a multi-pronged approach to questioning patients about GP access, to an all powerful tool, with much tougher targets, which GPs have found difficult to hit.

It will cost £8m to run annually. But its cost to general practice could be much greater.

The extent of the losses in England

Total loss to general practice = £26,877,308
Average loss per practice = £3,295
64% of practices fail to meet 90% threshold for PE7 (48 hour access)
82% of practices fail to meet 90% threshold for PE8 (advance booking)

The GP Patient Survey is expected to have cost general practice £35m The GP Patient Survey is expected to have cost general practice £35m

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say