Patient views worth £20,000

Increased emphasis on patient surveys in the revised GMS contract means that up to £20,000 for the average practice in England will depend on patient opinion.

GPs fear that the surveys could undermine patient care because they lack rigour and could magnify health inequalities.

Two thirds of payments under the directed enhanced service (DES) for access - £1.37 out of a possible £2.06 per patient - will depend upon positive feedback from patients.

Half of the choice DES payment - 48p out of a possible 96p - is contingent on patients recalling that they had a discussion about choice of secondary care provider.

However, in Wales an access DES will reward practices simply for conducting an access survey.

While GPs view patient opinion as important, some believe the surveys could provide a distorted and incomplete picture of practice achievements.

Last year, a GP survey found that a quarter of GPs wanted the patient survey scrapped, and half wanted it to attract fewer points.

GPC member Dr Chaand Nagpaul praised the idea of patient surveys, but added: 'I would be hard pressed to say the survey findings in the quality framework are representative. To compare or reward practices on the basis of them is premature.

'Until now, the surveys have been laborious to fill out. In my practice no non-English-speaking patients have completed them.'

To maximise their score on the access DES, GPs in England need positive feedback on four elements of the patient experience survey. Three elements - 48-hour access, advance booking and patients' ability to get through on the telephone - each attract 41p per patient and require 40 or 50 per cent positive feedback to trigger any payment. The fourth element - access to a practitioner of choice - attracts 14p and has a 40 per cent threshold.

Dr Nagpaul fears this payment system could magnify historical inequalities.

'One of the clear disparities between practices is between the starting levels of their telecommunications infrastructure, and medical and other staffing levels, all of which will have an impact on patient survey results,' he said. 'It would be better to reward practices for identifying solutions.'

Chairman of the Small Practices Association Dr Michael Taylor welcomed the increased weighting of surveys.

But he added: 'They need to distinguish between accessibility and convenience. Small practices may be inconvenient, but they are highly accessible.'

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