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DH considers boosting patient survey scores for GPs in deprived areas ‘by up to a fifth’

The Department of Health is considering adjusting the satisfaction scores practices receive under the patient survey, after a study found those in more deprived areas were being unfairly represented.

The move comes as the Government announced NHS Choices will display more information from the survey, with a new measure of ‘patient experience' included on the site from this month.

The study – from one of the architects of the patient survey - recommends patient satisfaction scores should be uprated for practices with younger, more deprived or lower proportions of white patients to give them a ‘level playing field'.

The analysis, published in the BMJ Quality and Safety journal last month, showed the current survey encouraged GPs to ‘cream-skim' and exclude hard-to-treat patients.

They analysed data from more than two million people registered with 8,267 primary care practices in England and looked at their scores in the 2009 patient survey.

They found case-mix was a powerful factor in influencing the results, resulting increases in scores for certain questions of more than 20% for some practices when adjusting for age, deprivation and ethnic mix.

The 10% of practices that benefited most from case-mix adjustment had a case-mix with 35% of patients below the age of 35, 45% white and 82% counted as deprived.

This compared with the case-mix at the 10% of practices who gained the least by the adjustment, who had 9% of patients below the age of 35, 97% white and 11% counted as deprived, on average.

The authors concluded: ‘We propose that such adjustment should be applied because it meaningfully improves performance measurement for practices with less typical and often under-privileged patient populations.

‘This would discourage practices from "cream-skimming" by avoiding enrolling patients who could be seen as "hard to treat".'

Study leader Professor Martin Roland, professor of health services research at the University of Cambridge, said practices in these areas ‘may feel there isn't a level playing field'.

He said: ‘Even though they are providing the same standard of care, it may not appear to be as good.'

A Department of Health spokesperson said they were considering the study's conclusions, but no case-mix adjustment would be included in this year's survey.

The analysis comes as the DH announced a new measure based on responses from the GP patient survey would be included on NHS Choices.

 It will score practices in England out of ten for measures such as GP listening skills, how convenient it is to get an appointment and the length of time patients wait in reception.

Ministers say the patient experience measure will give patients an idea of ‘exactly what the experience of being a patient at each GP surgery is really like' and will drive up ‘standards in the profession'. But GP leaders strongly criticised the plans as ‘demoralising' for the profession.

Dr Richard Vautrey, deputy GPC chair said: ‘It is simplistic nonsense to try and reduce the rich quality of general practice to a single number. It will mislead not help patients.'


Winners and losers from case-mix adjustment

Patient type

10% of practices that benefit most


10% of practices that benefit least


Below the age of 35










Source: BMJ Quality and Safety 2012, online 23 May