The folly of basing pay on patient surveys

There was worrying news this week for practices hoping to hit the achievement target for the choice and booking DES.

The DoH sheepishly released the results of a national survey of the patient choice initiative since January, when GPs were supposed to start offering a selection of at least four hospitals for a first inpatient appointment. It did not make comfortable reading for ministers, which is probably why the figures were buried in a press release about patients soon to be booking hospital appointments on computers at their local library.  

Only 30 per cent of the 79,000 patients surveyed could remember being offered a choice of hospital. So it seems unlikely that many practices will reach the 60 per cent target when the questions are put to their patient populations — and for the average practice there is almost £3,000 riding on the answer.  

Incidentally, the response rate to the survey was only 29 per cent. And 7,000 completed surveys had to be discarded because of insufficient information about the patient’s PCT or trust. If nothing else, the DoH seems to have uncovered a national crisis in memory function.  

We already know that patients retain only a fraction of information imparted in a GP consultation and choice of hospital is clearly not high on their agenda. The DoH figures showed that only half of those who were aware they should be offered a choice later recalled being offered it. And 57 per cent of those given a choice, not surprisingly, said that location or transport considerations were the most important factors in their decision — in other words, they wanted to go to their local hospital.  

The lesson for GPs is that patients have poor memories and need to be constantly bombarded with information about this flagship government initiative if the DES payment is to be achieved. But fear not — your local library will be there to help. Lord Warner’s press release promises ‘choice-trained’ librarians, broadband computers, plasma screens, banners and posters. The DES money should be safe, as long as your patients can remember how to find the library. 

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