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Independents' Day

Patient survey losses of £25,000 as Hewitt legacy bites GPs

New dispute between Government and GPC as early survey results indicate losses of up to £9,000 are the norm.

By Gareth Iacobucci

New dispute between Government and GPC as early survey results indicate losses of up to £9,000 are the norm.

When Patricia Hewitt first unveiled proposals for a controversial new patient survey back in 2006, the already widely reviled health secretary cemented her status as GPs favourite hate figure.

The decision to spend more than £11m of taxpayers' cash on a patient satisfaction survey, which many feared was deliberately designed as a weapon in the Government's PR war against the profession, left a bitter taste.

The GPC chair at the time, Dr Hamish Meldrum, described the exercise as ‘£11m wasted to demonstrate the bleeding obvious'.

The Government's decision to ramp up the survey this year provoked renewed fury from GP leaders.

By merging the four-question GP Patient Survey with a second survey - the national Patient Choice Survey previously carried out on site in GP surgeries – a mammoth 49-question tome was created, which the GPC predicted would lead to low response rates.

Yet few realised just how low and just how high the cost would be for practice finances.

As results come in across the UK from the third full year of the patient survey-the first under the new methodology and the last before it switches to a new quarterly format- practices have been left shocked at losses described by GP leaders as ‘devastating'.

Pulse this week reveals that some practices will lose up to £25,000 on the back of the views of what in many cases amount to a tiny fraction of patients.

The Government may have shaved £3m off the cost of the survey this year but it's slicing into practice income, all in the name of patient power.

The new look survey, once again carried out by Ipsos MORI, now rewards practices for access achievements through the QOF, rather than through a DES, with practices dependent on two sets of questions covering rapid access and advance booking.

GPs previously earned money under a DES for the MORI survey and via QOF from the choice survey.

The source of this week's carnage is the humble sounding PE7 and PE8 questions, which ask if patients were able to see a GP on the same day or in the next two days, and whether they were able to get an appointment with more than two days in advance.

They are worth up to 23.5 and 35 QOF points each. And with each point worth around £130, for an average practice, with 6,000 patients, it adds up to as much as £7,500.

But Pulse has learnt that a large number of practices, particularly bigger ones, are losing far more, after the Government moved the goalposts to make the survey tougher.

Results in Scotland came in first, with all but a relative handful of the 1,025 practices set to lose money and BMA leaders claiming that around 15% of practices will lose all 35 points for question PE8.

GPs have been left reeling with losses north of the border of up to £16,000 for some practices.

But this figure has now been dwarfed as the figures come in for England.

Pulse this week reveals that losses of up to £25,000 are being reported, such as that which has left Dr William Delaney, a GP in Nottingham, raging.

Based on what he calls a ‘very small sample' of patients, Dr Delaney's .

satisfaction score has slumped from 91% in last year's MORI survey, to 76%.

‘This cheating Government have scammed us just as they allowed their MPs to scam the taxpayer,' he fumes.

But he is far from alone. It is emerging that in cities across the UK, huge numbers of GPs face big losses.

Dr Kailash Chaand, a GP in Ashton-under-Lyne, and GPC member, predicts up to half of the GPs in Greater Manchester will lose between £2,000 to £10,000.

Dr Andrew Mimnagh, a GP in Sefton, has been told he will lose £8,000 and slams the ‘hideously complicated' methodology of the revised survey.

‘Losses of £6,000 to £9,000 seem to be the norm for the people I have spoken to,' he says.

So why have GPs done so badly?

The awful irony is that the results so far are anything to go by, patients' satisfaction has improved in the past year.

Last year, 87% of patients who responded to the patient survey said they were able to consult a health professional within 48 hours. Results in so far suggest that satisfaction levels stand at 90%.

But the sucker punch for GPs was the decision to up the thresholds.

Under the DES, thresholds for the two questions were 50-90% for PE7, and 40-90% for PE8. However, these have now been hardened to 70-90% for PE7, and 60-90% for PE8.

Evidence is also emerging that larger practices are being particularly badly hit compared to single-handed and smaller practices.

Dr Andrew Buist, chair of Tayside LMC and deputy chair of GPC Scotland, who stands to lose £7,000, says: ‘Generally, small practices have done better than big practices. That doesn't necessarily reflect better access, it's just the way I think patients have interpreted the question.

‘If you are a patient in an 8 doctor practice, and phone up for an appointment in 3 days time, you may well be offered an appointment, but it might not be with the doctor that you want. And then when you are asked the question, you say ‘no'.'

Other GPs fear that areas with high levels of ethnic minority patients may also be leading to poor response rates.

Dr Kambiz Boomla, a GP in Tower Hamlets, East London, where a quarter of residents are not literate in English, says the fact that the survey is sent out in English only, with patients then invited to request a survey in their own language if they wish, will have a massive impact on response rates.

The smaller the response rate, the more likely that a few vocal patients can influence the results of the survey either way and sadly for GPs it appears to be downwards.

The controversy looks like turning into a massive dispute between the Government and GPs, which could dwarf anger over losses from changes to the QOF formula.

Across the UK, thousands of GPs are set to challenge the results, with the BMA urging practices to appeal.

In Glasgow alone, Pulse understands 170 out of 270 practices are to appeal against their results.

But they could be in for a nasty shock. Andrew Lockhart-Mirams, a long term adviser for the BMA, told Pulse: ‘I honestly don't think there's a lot that can be done.

‘The reality is that any survey like this is going to be open to abuse,' he warns. ‘But I just don't see the door open for a massive series of appeals.'

The Department of Health claims that the GPC agreed to the survey, and so can have few grievances, leading to simmering discontent among some GPs, who feel the GPC has agreed once again to a whole new set of winners and losers, following the rows over the QOF and MPIG.

GPC chair Dr Laurence Buckman seethes at the Government's suggestion. ‘This survey was most definitely not agreed, at all,' he says angrily.

‘We've spoken against it from the very beginning, arguing it wasn't fair, and that the questions were bent.

‘What was agreed was that there would be a survey, the statement of financial entitlement, and the things in it. That it true. But the questions in the survey, and the fact it was posted rather than handed out were not agreed.'

The GPC is already engaged in showdown talks with ministers but the Department of Health is refusing to admit the survey's methodology has led to some practices being inaccurately penalised.

‘The survey methodology was carefully designed to ensure that the confidence intervals for practice-level results are comparable to those from previous years' surveys,' says a spokesperson. ‘ This included sending out a greater number of questionnaires than in previous years to allow for the possibility of a lower response rate.'

Try telling that to Dr Natalino Marcuccilli, a GP in Glasgow who stands to lose £16,000 on the back of responses from 51 of his patients.

He says the losses have left him ‘demoralised' and it looks as if for many GPs across the UK, the same could be true.

GP patient survey: Practices reporting losses of up to £25,000

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