Focus on...the GP Patient Survey (PES)
October 2006 (updated October 2007)
- How will the data be gatherd? - go to this section
- Points for practices to consider - go to this section
- The GP patient survey 2006/07 - go to this section
- The GP patient survey 2007/08 - go to this section
- What is the GP patient survey? - go to this section
1. What is the GP Patient Survey (GPPS)?
The GPPS emerged from the 2006/07 contract review negotiations as a means of measuring achievement in the “Improved Access Scheme” and “Choice and Booking” DESs. The survey's full title is now 'The GP Patient Survey - your doctor, your experience, your say'. The survey is not related to the GP patient survey in the Quality and Outcomes Framework (QOF). The questionnaires for this year's survey will be distributed to patients in January 2008, in England only, with a deadline of April 2008 for responses.
The GPC fully realises that determining payment based on patient response is controversial and understands the problems that this approach may cause. However one condition of the contract review for 2006/07 was that the investment for access targets would only be released if the majority of it was tied to achievement measured by a patient survey. The GPC took the decision that it was better to secure the availability of this investment for general medical services (GMS) and personal medical services (PMS) practitioners, rather than seeing it diverted entirely to alternative provider medical services (APMS) providers, which would have been the alternative.
2. The GP Patient Survey 2006/07
The GPPS 2006/07 questioned patients on:
- their satisfaction with practice opening hours,
- the ease of getting through to their practice by phone,
- obtaining an appointment within 48 hours,
- booking appointments in advance.
Despite these positive results, the GPC remains critical of the survey. The survey only serves to confirm what existing patient surveys and studies have already revealed, and as such the GPC considers the cost of executing the survey (£11 million) to be an imprudent use of scarce NHS resources.
3. The GP Patient Survey 2007/08
Like last year, in 2007/08 the GP Patient Survey will comprise an Access questionnaire, sent directly to patients, and a Choice questionnaire, sent to practices to be handed out to patients. Further details on the two components of the survey, together with information about the data extraction methods to be used in the 2008/09 survey, are outlined below.
3.1 What is the timetable for the 2008/09 Survey?
Patients selected for the Access survey will receive the questionnaire from 7 January 2008 onwards, with final return date of 2 April 2008 for responses. The Choice survey will run for 10 weeks from the 21 January. Detailed survey results will be made available in June 2008, however primary care trusts (PCTs) will be informed of the survey results in May 2008, to enable qualifying practices to receive their reward payments in the first quarter of the 2008/09 financial year.
3.2 The ’Access’ Component of the Survey
The Access questionnaire includes questions relating to contacting the practice by telephone, booking appointments both within 48 hours, booking appointments in advance, and practice opening hours. Questions asking for demographic information will be included this year. Patients will be asked for information relating to working hours and distance from work, and how this affects their ease of access to a GP. The Access questionnaire includes two questions on choice at the point of referral to hospital. This question was included this year with a view to moving towards a single questionnaire covering both choice and access. The results of these choice questions will not be used to determine payment to GPs.
The GPC remains critical of the inclusion of the questions set out below, which prompt dissatisfied patients to outline the reasons for their discontent.
Q9 Over the last 6 months or so, were you satisfied with the hours your GP surgery was open?
Yes, I was satisfied with the opening hours….. [Please go to section B]
No, I was dissatisfied with the opening hours……[Please answer Q10]
Q10 I was dissatisfied because…
Please tick the one box closest to your views
the surgery was not open early enough in the morning
the surgery was not open around lunchtime
the surgery was not open late enough in the evening
the surgery was not open on a Saturday
the surgery was not open on a Sunday
or some other reason.
Whilst these questions are not to be linked to DES pay, the second question is potentially pejorative and seems to encourage the patient to respond that there have been problems obtaining an appointment at the practice. It offers patients ’solutions’ that have not been on offer because they are not in GP contracts agreed with the Department of Health and signed up to by previous Ministers.
The GPC made every attempt possible to have these questions removed or couched in more acceptable wording in 2006/07, and still refutes the inclusion of these questions in the 2007/08 survey.
3.3 The ‘Choice’ component of survey
The Choice component is linked to payment of the Choice element of the Choice and Booking DES. The survey asks patients to recall a recent Choice referral, and answer a question relating to the discussion that took place.
Due to the indiscriminate nature of the Exeter system for data extraction, it is necessary to issue separate questionnaires for the Access DES and the Choice and Booking DES, in order to ensure that patients responding to the latter have experienced a referral relevant to the Choice criteria. The Choice questionnaire will be sent to practices in January 2008, and as in 2006/07 there will be a reimbursement payment to practices for handing out the questionnaires.
This year practices may issue the questionnaire to patients who have experienced a Choice referral from 1 September onwards. Practices can use the relevant Choice Read codes to identify eligible patients:
- 9kK.. Choice and Booking- enhanced services administration ( 4 byte and version 2)
- XaMJa Choice and Booking- enhanced services administration (version 3)
- 222711000000102 Choice and Booking- enhanced services (SNOMED).
Apollo Medical Systems software is not being used for the 2008/09 survey, due to concerns expressed by the Patient Information Advisory Group (PIAG). PIAG were dissatisfied with the security of patient information in Apollo, and were concerned that information about referrals or appointments may have been used to select patients. This year the NHAIS (Exeter) registration system will be used to select patients at random from practice lists. This involves taking a larger sample to ensure that a sufficient number of patients extracted have had an appointment in the last six months. Data processing agreements will be put in place between PCTs and Ipsos MORI.
4.1 What data will be extracted?
The patient data to be extracted will comprise:
- Patient’s NHS Number
- Name
- Address
- Date of Birth
- Gender
4.2 Practices that do not want patient data extracted at all
Practices that do not wish to participate in GPPS should inform their PCT or email the Department directly. Emails should be sent to GPPatientSurvey@dh.gsi.gov.uk by the 30 November 2007, indicating which DES (Access, Choice or both) the practice wishes to opt out of.
Practices should be aware that not participating will mean that they will forfeit achievement payment under the DES. Furthermore, PCTs may decide to claw back any preceding payments made for participation in the DES where it is decided that practices have not complied with their obligations as set out in Direction 5 of the DES Directions.
The GPC is aware that in forfeiting the achievement award and having to repay the initial payments the average practice could be losing up to £12,000, depending on the level of achievement gained.
4.3 How can a patient opt-out of participating?
Patients who receive the survey are not obliged to complete and return the questionnaire. Patients who object to receiving the survey through the post can ‘opt out’ of the survey, by informing their practice or PCT. The practice or PCT should email the relevant patient name and NHS number to GPPatientSurvey@dh.gsi.gov.uk by 30 November 2007, with the title ‘Patient opt out 2007/08’.
5. Points for practices to consider
5.1 Standard contract variations incorporating the Access and Choice DESs
The GPC is aware that nGMS Standard Contract variations incorporating the new Directed Enhanced Services (England) were released in September 2006. These provided an optional set of contract variation documents that may be used by practices and PCTs as a means of incorporating the DES arrangements into the standard GMS contract, modifying the standard GMS contract by agreement.
The standard variation notices do not tie practices into any arrangements additional or different from those already set out in the DES Directions and SFE amendment. However, they do contain the following term;
’The Contractor must co-operate with the PCT in facilitating the carrying out of the national GP Patient Survey in respect of the Contractor’s practice.’
Practices that have signed up to a variation that contains this term should be aware that they may well be in breach of contract if they choose not to participate in the survey.
5.2 Should practices continue to participate in the DES?
Practices will need to decide whether they wish to cooperate with a survey that contains a question which:
(a) the GPC did not agree to
(b) risks raising patient expectations of an extended service that the Government has not demonstrated it can fund
(c) appears to be biased in its design so as to create negative perceptions of access to GP services. In a DES intended to improve access collaboratively, this is completely inappropriate.
Details for opting out of the GPPS are outlined in section 4.2 above.