Government report suggests tying some GP payments to patient satisfaction
The Government should consider different ways of funding general practice – including partial payment for a GP practice only being ‘released’ if ‘a certain proportion of patients confirmed they were satisfied with the waiting time before their appointment’, an analysis conducted as part of the 10-year health plan has recommended.
The new report, produced by a 10-year plan working group, also said that the Carr-Hill formula review should include ‘additional funding’ to balance out winners and losers.
The Government published the working group report setting out ‘a range of options’ for the NHS financial framework ‘intended to meet the objectives’ of the 10-year plan – which had included a promise to review the formula for GP funding.
The report recommended several options, including payments to incentivise GP access, putting in additional funding to balance potential winners and losers, and moving a greater share of funding outside of GMS.
It comes as the National Institute for Health and Care Research (NIHR) has been asked by the Government to produce an ‘overall recommendation’ on replacing the Carr-Hill formula, which could include a departure from the existing approach.
Pulse exclusively revealed that GP leaders had been told the review may have to be ‘cost neutral’.
But now the report has acknowledged that ‘any change’ to the formula ‘will create winners and losers’ and said that a ‘transition approach will have to be agreed’ and involve ‘balancing sharp changes’ either using an ‘extended implementation period or putting in additional funding’.
And considering NHS funding more widely rather than specifically in relation to the review, the group also said the Government should consider the introduction of ‘payments which incentivise reducing avoidable admissions, worse health outcomes and higher costs’.
Members of the group suggested exploring how this type of financial levers ‘could help improve GP access’, adding that this could mean in practice ‘partial payment’ for a GP practice would only be released if ‘a certain proportion of patients confirmed they were satisfied with the waiting time before their appointment’.
The 10-year plan had proposed to trial ‘patient power payments’, introducing a new funding flow in which patients are contacted after care and given a say on whether the full payment for the costs of their care should be released to the provider – but at the time it was unclear whether this would include general practice.
The relevant recommendation in full
Recommendation 5. Explore options for outcome-based payment or proxies thereof. One option worth considering is more patient experience-influenced payment mechanisms to drive up quality and potentially productivity. This might mean partial payment for an episode of care would only be released to the provider, if patients confirmed they were satisfied with the care they receive. Another option to consider includes the introduction of payments which incentivise reducing avoidable admissions, worse health outcomes and higher costs, which is not captured as part of the patient experience assessment. Members of the group have also suggested exploring how this type of financial levers could help improve GP access. Practically, this could mean partial payment for a GP practice would only be released if a certain proportion of patients confirmed they were satisfied with the waiting time before their appointment.
The working group report also said that the Carr-Hill review should consider ‘keeping a greater share’ of funding ‘outside the main contract’ and using it to ‘directly incentivise staff participation’ and support enhanced services in the most challenged areas.
Specifically on the Carr-Hill formula review, the report said: ‘Transition to any new funding formula would need to be carefully managed to minimise service disruption as it secured the benefits of change and may be dependent on the level of funding available.
‘Any change to the Carr-Hill formula will create winners and losers. The age of the formula means these may be significant, and they may be further exacerbated by a more radical switch from a workload-based model to, say, a need-based model.
‘A transition approach will have to be agreed and involve balancing sharp changes with protection of losers either using an extended implementation period or putting in additional funding. It will be necessary to ensure funding shifts are accompanied by the development of service delivery models well-suited to meeting currently unmet need.’
The report also said that the review ‘should be widened’ to consider ‘other approaches to funding primary medical care’, including to continue to flow ‘most funding’ through the GMS contract, with ‘an improved payment formula’.
But the working group also said other options could be considered, including ‘capitated budget based on GP registered populations’.
The group also suggested that beyond the review of the Carr Hill formula, ‘future discussions on the GP contract’ should consider how it could be used as ‘a vehicle to further incentivise prevention interventions’.
The Carr-Hill formula currently considers six elements:
- rurality (measured using tax information on GP expenses);
- patient’s age and sex;
- additional patient needs (for instance, associated with morbidity and mortality);
- list turnover (new patients have more consultations, so more funds are needed);
- number of residential and nursing home patients;
- and staff market forces (differing staff costs depending on location).
But experts and GP leaders have argued for years that lacks a real measure of socioeconomic deprivation.
Last month, medical accountants recommended that the review should result in a ‘separate funding mechanism’ for rural and atypical practices, medical accountants have recommended.
The 10-year plan had announced the development of ‘year of care payments’, which will introduce a capitated budget for a patient’s care over a year, including all primary care, community health services, mental health, specialist outpatient care, emergency department attendances and admissions.
Pulse has previously looked closely at how the 10-year plan could affect GP funding.
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READERS' COMMENTS [18]
Please note, only GPs are permitted to add comments to articles
The report actually concentrated more on how to bridge the health inequality divide and the future demographic calamity( I remain perplexed at why few colleagues discuss this). Recommendation 2 states ‘ The Carr hill formula should be reviewed…. through the traditional GP model or alternative approaches’ Yes please alternative approaches that fully staff GPs and others helping in multidisciplinary teams. For too long our leaders have ignored those who work in the hardest areas using them as PR examples instead of representing these doctors and their patients best interests.
“This might mean partial payment for an episode of care would only be released to the provider, if patients confirmed they were satisfied with the care they receive.” – This is absolute lunacy. Can we arrange to pay MPs a % of their wage based on their constituents happiness with their encounters?
Good medicine does not always leave a patient satisfied – a person attends seeking inappropriate referral/medication/MED3 or has demands incompatible with GP provision is not receiving bad care if they are told that they cannot have what they want.
This seems sure to disproportionately affect practice that deal with these sorts of issues and will create yet another divide in funding receipt.
Absolutely agree with the last comment
Once again working in deprived areas with challenging patients inevitably is not going to get the satisfaction ratings of managing a group in a leafy suburb who will have private health insurance.
It is these high demand high pressure practises that really need extra funding to level the playing field
It’s almost too easy: Let’s tie politician income to public satisfaction at the same time!
Ultimately I think the problem is that most politicians are not really interested in the quality of patient care. What concerns them is their own popularity as this is tied in to how many votes they will get. If bashing GPs makes them win votes they will do it whatever disastrous consequences it has for their constituents who are our patients.
I can’t think of a better way to increase healthcare costs, without actually improving health outcomes.
If payments are linked to satisfaction, my patients are getting all the paracetamol and emollient cream they want on prescription; they can have their atorvastatin as a special suspension at £600 per week if they prefer; and Mounjaro for everyone with a BMI over 28 and especially those with an eating disorder.
Maybe not the eating disorders….. but that would improve my satisfaction scores if that is what the government seems to care about most.
“The GP told me what they thought I needed to hear, but I wanted to hear what I wanted to hear. They seriously expected me to take some responsibility for my own health comes. One out of five.”
“Government report suggests tying some GP payments to patient satisfaction”. hahaha, easy just give all the patients the things don’t actually need and are inappropriate – diazepam, antibiotics, etc.. It is often hard to do the right thing, it takes longer and patients somethings don’t like it.
Wonder what the politicians would say if it was suggested their pay be linked to satisfaction…
Deprived areas suffer the most. The type of patients are irresponsible. They smoke, drink, take drugs, have mental health and safeguarding issues and don’t turn up for appointments, follow ups or QoF. They have more diseases and need more appointments but they blame the GP.
Are they going to do the same with hospitals is patients aren’t happy with their waiting times?
Can’t imagine the 1 year gynae waiting list or two year dermatology contains many happy punters
This is further dumbing down and devaluing of expert opinion. We should be providing what people need not what they want. The NHS fiscally needs GP’s to say no at times. This is already hard with multiple complaint options to patients that consume clinical time disproportionately. Dole out Med 3 benzodiazepines and painkillers inappropriately and get well paid for it. Patient power is not a panoply for good medicine and indeed may have damaging effects.
Why add the step of patient satisfaction unless you don’t really want to pay for activity?
Either pay for activity – thus ensuring practices with high demand get paid more – or don’t, but don’t use an awful proxy measure.
It was John Major who introduced the Patients Charter making healthcare consumer-driven and supercharging Demand. This “patient satisfaction” measure will alter GP behaviour towards complying with patient demands thus increasing costs for the NHS – which, funnily enough, serves big pharmaceutical companies interests.
Having worked in a deprived area of a northern city I am fairly sure I was low on the satisfaction rating of the patients we had arrested for threatening violence to the staff or to burn the building down because their repeat prescription was not done instantly.
The NHS provides care at the point of need, not want. What idiocy to suggest we are paid to please patients. Diazepam, sleepers, gapapentinoids, and unfettered referrals for everyone means I’ll have happy patients and a guaranteed payment…. at the expense of my medical integrity
Far too complicated. Easier to have NHS funded fee for servicr. Pay on patients being seen and sevices provided to them. Zero patients seen is zero pay, a busy day, 30 plus then tired but fatter wallet. As in Australia where GPs seem happier and long waits to see GP almost unknown.
Sorry Shaun Meehan, I have not read the whole report, but looking at Recommendation 5 it encapsulates the problem we have had. Reducing avoidable admissions means good continuity of care, and proactive care. These are at odds with rapid access to GP for all patients. In our resource limited system we cannot have both. I am with Conor and Mark on this: Improved Access and Satisfaction should not be markers of success – and we should not be paid based on these.
Dissatisfaction all round in deprived practices. We can’t prescribe people out of poverty.