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GPs criticise negotiators over patient survey deal

The GPC is claiming it had an agreement with the Government that results of the GP Patient Survey would only count if found to be statistically robust, as the negotiators come under pressure over exactly what they signed up to.

Some GPs have turned their fire over the patient survey debacle onto GP negotiators for agreeing toughened payment thresholds, after it emerged some practices had lost substantial amounts even though they scored higher on the survey than last year.

The GPC put the blame for losses firmly on poor response rates, and claimed its agreement with the Department of Health stipulated a stringent ‘tolerance level' for statistical error, which had not been met in many practices.

But the DH dismissed the GPC's claims out of hand, insisting GP leaders signed on the dotted line to the full survey package, and that even a single survey response would be sufficient for the results to count.

The GPC is now facing criticism from some GPs for agreeing to tougher QOF thresholds for the patient survey, which are emerging as a key reason for practices losing money – in some cases as much as £25,000.

Lower payment thresholds rose from 50% to 70% for question PE7, on access to GPs within two days, and from 40% to 60% for question PE8, on booking advanced appointments.

Dr Natarajan Chandra, a GP in Dewsbury, West Yorkshire, said his practice had improved its scores from last year but lost £4,200 because of the higher thresholds: ‘We improved from 80% to 83%, and from 73% to 81%. But we lost out.'

Dr Alan Keith, a GP in Rotherham, West Yorkshire, said the GPC had signed up to ‘yet another way of taking money off GPs in deprived areas'.

And one LMC member, who wished to remain anonymous, added: ‘Did they not foresee this? The GPC has to take responsibility.'

But GPC negotiator Dr Chaand Nagpaul said it was the Government's ‘moral duty' to act, as a ‘significant' number of practices were falling outside agreed confidence intervals, making the results ‘statistically invalid'.

Dr Nagpaul said: ‘This is not down to the thresholds. The problem was sending a questionnaire of 49 questions and expecting patients to fill it in.'

The Government claims the BMA has nothing in writing to back its case. In a letter to primary care organisations it states: ‘Neither the Statement of Financial Entitlements nor the QOF guidance contain stipulations about confidence intervals or sample sizes. The SFE does not require a minimum number of responses; one response is sufficient.'

A breakdown of the first 1,000 results released has added to fears that practices in deprived populations are likely to be worst hit. Practices in the most deprived quarter had a response rate of 42%, compared with 58% in the least deprived quarter, making an unrepresentative survey result more likely.

Dr Natarajan Chandra: 'We improved our scores but still lost out' Dr Natarajan Chandra: 'We improved our scores but still lost out' What is the dispute about?

• GP leaders insist they had an agreement with the Government that, for the two payment questions on the survey, the proportion of responses should be high enough to have a 95% chance the ‘true' result would be within 7% of the measured result

• Of results revealed so far, nearly a third have fallen outside that level, with the BMA claiming the practices affected all have a right to appeal

• The DH admits the sampling approach used by Ipsos MORI
for the survey used the 7% ‘tolerance level' but claimed it was ‘inevitable some practices' results might be outside this'

• It claims the latest survey involved a larger number of forms being sent to areas where there was a low response rate last year, which it says ‘preserves the statistical robustness of the survey'

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