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Gold, incentives and meh

Hasty PCT mergers could scupper GP commissioning

Am I master of

all I survey?

Anticipating a rash of patient surveys, Andy's off to add coollant to the copier ­ and the practice manager

Summer always guarantees three things: rain at Wimbledon, hosepipe bans and patient surveys. The BMA polled the public on their priorities for the NHS just before its annual conference this year. Sceptics might say the idea was to embarrass the invited political speakers. Hey, it's always good to see ministerial strategy under fire.

Two thousand members of the public were asked to rank 10 NHS spending priorities. Cleaner hospitals (a BMA priority) came top, along with improved A&E and shorter waiting times. Patient choice ­ the Government's flagship policy ­ came bottom. Now, correct me if I'm wrong, but haven't we all had 'more choice' driven into us like acupuncture needles over the last three years?

So either the public's priorities have changed, the BMA has massaged the survey or, just conceivably, choice never was actually a priority for the public and has been introduced as a political diktat by means of dubious surveys.

Having an influence

Health care surveys have been problematic before. We all know they can be influenced: 100 points of the new contract are available for taking a sounding from the waiting room.

Surgeries are well advised to choose quiet sunny weeks with a full complement of staff to run approval ratings. Booming welcomes and smiles can be reintroduced for entire mornings. Patients repay the compliment with a few extra complaints in their opening gambit and leave with an extra quota of Viagra, nicotine patches or NHS-subsidised sun cream. Receptionists can ensure randomisation beyond statistical reproach by handing questionnaires to their favourite regulars. The results can then be interpreted to reinforce projects long since under way or delivered.

So, is the plan to reduce our dependence on surveys? No. Surveys are now the backbone of the Healthcare Commission's work. Patient experience will be monitored by Big Brother at national level and made available in expanded league tables.

The Department of Health's slogan 'national standards, local action' rings a little hollow with the barrage of bureaucracy swallowing the NHS.

Turning up the heat

I've saved the best for last. PCT surveys are currently being reviewed, turning the heat on our paymasters. You can guess what's next for us.

Bet on a centrally generated survey with the results uploaded to the Healthcare Commission database. And just before I change my name to George Orwell by deed poll, we will soon all have the pleasure of doing two chronic disease patient satisfaction surveys each year.

Diabetes will be first, in spring 2006. The tender for organising this is currently under discussion. The only name I have seen in the frame is the Picker Institute, a specialist patient survey charity we are all likely to hear more of in future.

I'm just off to add coolant to the photocopier and the practice manager before I pass on the good news.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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