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At the heart of general practice since 1960

This flawed survey is sucking cash from most-needy practices

Practices in deprived areas need extra support and funding to help them cope with the complex needs of their patients, yet the GP Patient Survey is draining resource away from them, warns Dr Zara Aziz

Practices in deprived areas need extra support and funding to help them cope with the complex needs of their patients, yet the GP Patient Survey is draining resource away from them, warns Dr Zara Aziz

The GP Patient Survey, which has become so familiar to us, is soon going to move from an annual event to run quarterly for the next three years. The survey is administered by Ipsos-MORI and already costs around £10m a year.

The Department of Health believes the survey effectively gauges patients' satisfaction with primary care services and hopes the results will have an impact on the way those services are delivered. But in fact serious flaws in the survey's methodology mean it is unreliable and in particular gives an unfair representation of the care offered by inner-city practices.

Questionnaires are posted to randomly selected patients registered with a GP, and assess areas such as access to appointments, opening hours and quality of care. But as someone who has worked in both a leafy suburban and an urban practice and undertaken previous individual CFEP-UK surveys, I know how much results can vary.

Mine ranged from very good at the rural practice to average at the urban one in the space of just a few months, despite similar consulting techniques and the added experience I had gained in the meantime.

The latest results for the Scottish patient survey show 90% of patients were able to consult health professionals within 48 hours, and these results are now being used to calculate the level of payments to GPs, through the QOF points allocated for achievement on access.

Yet changes to the methodology of the survey mean it's an unreliable way of measuring an inner-city practice's performance.

Unrepresentative views

Surveys were previously handed out in GP surgeries, which will have helped with response rates. But now they're sent out by post, and urban practices with poor uptake are at particular risk of missing out on funding - since patients with negative experiences are probably more likely to complete surveys than those who are satisfied with their care.

The surveys are long and not user-friendly, particularly not for ethnic minority groups, many of whom receive the English versions and not translated ones.

The views of a small sample of patients cannot represent the practice population.

In a surgery in Lanarkshire, the views of just 51 patients out of 18,000 are being used to determine potential payments, as Pulse reported at the end of last month.

The survey also asks leading questions designed to get the desired response. So, it asks: 'Which one of the following additional times would you most like the surgery to be open at...on a Saturday, Sunday' and so on. And it assesses listening skills, something it is difficult for patients to judge on in a 10-minute consultation, even more so when an interpreter is involved. Language barriers affect how telephone appointments are arranged and conducted too.

The results of the survey since 2006 have consistently shown that factors like age, ethnicity, list size and practice area all have an impact on the views of patients. Generally older white patients in small rural practices express satisfaction with their GP while the highest rates of dissatisfaction are among black and minority ethnic groups.

Just demographics?

Patient satisfaction is higher in those who attend the surgery more often, particularly for chronic conditions, than for less frequent attenders. But in large city-centre practices with younger populations, attendance is more infrequent, with many convenience or commuter users.

Patients in deprived areas are less likely to say that their GP discussed choice with them than at rural practices. There are often time pressures, with multiple or complex complaints hard to deal with in a 10-minute consultation. There is less satisfaction with telephone access in large urban practices across all the major cities.

But is demographics the only reason practices in urban and deprived areas consistently perform less well in these surveys? Or could it also be that the inverse care law, increased morbidity and heightened demand lead to dissatisfaction too?

The medical and social needs of patients in areas of high deprivation are often greater than in more affluent areas, as are the potential health benefits that primary care teams can deliver. There are higher rates of mental health problems but poor availability of counselling and psychiatry services. And these particular health needs, combined with cultural issues, contribute to a mismatch of expectations and inevitable dissatisfaction.

Many practices already devise and run their own surveys and use these to ascertain patient needs in an increasingly competitive market. Any business that does not respond to changing consumer demand knows that it cannot be viable and general practice is no exception. But the reality is that the majority of patients are happy with opening hours, access to appointments and with the care they receive from the practice team.

Should practices in deprived areas be penalised for aspects of healthcare that are outside their control, rather than receiving extra funding to bridge the inequalities gap? There are already increased levels of workload and stress among urban GPs.

In such areas, where there are high levels of unmet need, it is unrealistic to demand even more from overstretched healthcare staff.

Instead, the Government should fund more doctors, nurses and secondary care services in these areas. Access to counselling, social and community services needs to be addressed. This could partly be paid for by the money saved by no longer commissioning these inconsistent surveys.

Dr Zara Aziz is a GP in Bristol

Dr Zara Aziz

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