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This patient survey will distort the priorities of general practice

Randomly surveying practice lists might seem a good idea, but it dilutes out the views of the minority of patients who are most in need of care

Randomly surveying practice lists might seem a good idea, but it dilutes out the views of the minority of patients who are most in need of care

The GP Patient Survey, as it's now known, as had a bit of a PR problem from the start.

Contractual mechanisms linking GP pay to performance don't often make it into the pages of the Sun, but this one did, when it emerged it was due to cost the NHS 11 million.

But what's now getting GPs up in arms is what the latest iteration of the survey is costing their practices, after a rather sneaky change to its methodology.

It used to be that surveys were handed out at the practice, which at least had the benefit of ensuring the people who responded did actually know what the inside of the surgery looked like.

No longer, with the Department of Health introducing a new method – apparently with the agreement of the GPC – where surveys are instead posted off to a random selection of people on a practice's list.

This has had at least one fairly predictable effect, and will probably have another perhaps slightly less predictable one.

First to the obvious, and to no one's great surprise, the postal survey hasn't had the best of response rates.

In fact, the response rate has been downright lousy at some practices, particularly those in more deprived areas, with results in some cases based on as few as 50 filled-in forms.

Whenever you have small sample sizes there's a risk of results being skewed, particularly when a survey is as self-evidently self-selecting as this one.

Just a few irrationally angry patients who didn't get their sick notes or were sent away without an antibiotic script, and that's potentially thousands of pounds down the toilet.

But there's a more fundamental problem with this new methodology. It suggests the views of any one patient at a practice matter just as much as those of any other, which is all very nice and egalitarian, but doesn't actually reflect the way practices work.

The great majority of GP consultations are taken up dealing with a distinct minority of patients – the elderly and chronically ill – and practices have always worked very hard to ensure that this needy minority are looked after.

But the point of the GP Patient Survey is to make GPs more responsive to the needs of their customers, and that means everyone, whether they use a practice much or not.

GPs are being told to alter their priorities, to downgrade the needs of their hardcore of attendees, and to focus with ever greater concentration on the desires of the population as a whole.

In practical terms, that's likely to mean more extended hours, more walk-in clinics, more email consultations – but maybe not so many domiciliary nurses or annual elderly reviews.

Richard Hoey, Pulse editor

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