Exclusive GP practices are confused and overburdened with paperwork as they struggle to meet the terms of the patient participation DES introduced in this year's contract.
Just four months after the DES was launched, practice managers contacted by Pulse are questioning whether the terms of the new service are too prescriptive and whether they are ‘in the true spirit of patient participation'.
Pulse revealed in June that only four in ten GPs are shunning the new £60m DES, even though it will result in a loss in income as the funding for the service came directly out of a reduction in payments for extended hours.
Sheila McLean, a practice manager in Basildon, Essex, said:‘The DES is a huge issue at the moment. I went to meeting about it with 30 other practice managers and there was a sense of total despondency over some of it.'
‘It is just another way of putting practices under pressure to address patient access. It involves massive amounts of paperwork – you have to show evidence that you've tried to do everything you could to recruit patients from all elements of your practice population. You do all of this and you end up with £1.10 per patient which is nothing compared to the time and resources you put into all of this.'
‘There's confusion about so much of it. We don't know how many surveys to do. Someone at the PCT suggested we do about 5% of our patient population, another suggestion was that we do 100 surveys. It feels a bit like we're asking how long is a piece of string? It is unclear about whether we have to set up virtual patient groups or meet with people.'
‘Virtual groups sound good in principle but your group is meant to be representative of your patient population – if you do it via the internet you're already excluding people who aren't online. The message seems to be do a survey, put it on your website and then get paid – but that isn't, to me, in the true spirit of patient participation.'
In the midst of the confusion, the Family Doctor Association has launched a new factsheet and sample questionnaire to support practices, many of whom ‘didn't know where to start' with the scheme.
Moira Auchterlonie, chief executive of the FDA, said:‘We recently held a meeting of over 50 practice managers and the feedback was that people didn't know where to start with the patient survey.'
‘When the new QOF was announced this was the main area of concern because it is completely new. With the materials are providing we want to give practices a starter for ten, we want to make it easier for them to get this up and running.' Click here for the guidance.
Practices using NHS Choices as their website flagged up fears that they would be hit by £300 bills for website design in order to fulfil the DES's requirement to post patient survey results on a dedicated practice website. The DES guidance states that ‘where a practice does not already have a website one must be set up' and the BMA has confirmed ‘it will not be sufficient for practices to use their NHS Choices page to publish information relating to the DES.'
Jane Hemblade, a Practice Manager in West Sussex, said her practice used NHS Choices as its website but had been told it won't be paid for the Patient Participation DES unless they create a new dedicated site. She told Pulse:‘We use NHS Choices as our website but now we are told that it is not considered good enough for practices to utilise for the Patient Participation DES.'
‘We are now obliged to sign up to web site providers, possibly to the tune of approximately £300, or we will not be entitled to QOF payments despite carrying out the work.'
A BMA spokesperson said:‘The DES guidance specifically states that "Where a practice does not already have a website, one must be set up". It will not be sufficient for practices to use their NHS Choices page to publish information relating to the DES.'
‘However, it may be that practices setting up a new website will take some time to do so and it seems reasonable for them to share their opening hours information on NHS Choices until this is achieved. It would also be reasonable for practices to develop a shared website, for example as part of a commissioning group, as long as the information about individual practices was clear.'
Get advice on the patient participation DES at Pulse's Bold Practice Management Seminar.