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Patient survey losses to hit almost all GP practices

By Gareth Iacobucci

The full scale of the losses faced by GPs through changes to the GP Patient Survey became clear this week, with warnings that almost every practice was likely to be hit.

GP leaders predict only a handful will escape without losses, with 15% to lose all funding allocated to the most controversial question, asking if patients can get an appointment more than two days in advance.

Practices' losses have resulted from a combination of tough new payment thresholds in the QOF and low postal response rates in some areas – and despite patient satisfaction scores apparently increasing compared with last year.

Shortfalls faced by practices are predicted to hugely outweigh those caused by the recent changes to the GP contract.

Pulse can reveal:

•some practices have been hit by losses of up to £25,000

•hundreds of GPs have signalled plans to appeal their results

•a legal row is raging over whether the results can be overturned

•showdown talks have been held between the GPC and the Government.

The developments came as GP leaders furiously denied signing up to the small print of the survey, after suggestions by lawyers that the survey process might be impossible to challenge because it had been agreed through negotiation.

In Greater Manchester, LMC leaders have revealed up to half of GP practices have been told they will lose up to £10,000.

Dr Andrew Mimnagh, chair of Sefton LMC, said losses in his area averaged £6,000 to £9,000 per practice: ‘My own practice's loss exceeds the maximum loss of any practice in the area from the MPIG recalculation.'

Dr William Delaney, a GP in Worksop, Nottinghamshire, said his practice was set to lose a mammoth £25,000. ‘We have a list size of 34,000,' he said. ‘We only had responses from 1%.'

Dr Zara Aziz, a GP in Bristol who has worked in both deprived and affluent areas, said there would be a ‘marked difference' in patient satisfaction scores depending on location, with deprivation meaning both lower response rates and lower satisfaction.

‘A lot of people in deprived areas are not going to score well and never will.'

GPC chair Dr Laurence Buckman said the committee had held talks with ministers to try to resolve the dispute and had issued a template appeal letter to LMCs.

‘If the result does not accurately reflect the access you offer, you should consider appealing,' he said. ‘Our legal advice is that practices will be able to be successful.'

In Glasgow alone, 170 of 270 practices are to launch appeals against their results, with GPC Scotland saying very few practices would escape the losses entirely.

But the Department of Health appears confident it can withstand any challenge. A spokesperson said: ‘We do not accept the claim the survey scores are inaccurate.'

Dr Zara Aziz: 'GPs in deprived areas are never going to score well.' Dr Zara Aziz: 'GPs in deprived areas are never going to score well.' Justice on Patient Survey

Practices are facing devastating losses of as much as £25,000 through the patient survey.
These are partly because of agreed changes to QOF payment thresholds, with the lower thresholds rising from 50% to 70% for PE7 and 40% to 60% for PE8. These losses, though desperately unfair to practices, may be impossible to appeal.
But in some cases, GPs have seen huge losses because response rates of less than 1% of their practice list on the now postal-only survey have skewed results downwards. Here appeal is a real possibility, and the whole methodology of the survey may be open to challenge.
Help Pulse to build up a dossier of evidence of how practices have been affected by the changes, by contacting us with your scores, your response rates and your stories.

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