Choice questions dropped in survey dispute

Questions for patients on the choice element of the Choose and Book incentive scheme have been dropped from a national survey because of technical difficulties.

The decision means the Department of Health and GP representatives are now having further talks on how the offer of choice of hospital on referral will be measured for the choice and booking directed enhanced service (DES) in 2006/7.

The original plan was to include questions about whether a patient was offered a choice of hospitals alongside questions about access to GP services in a Patient Experience Survey. Choice questions have now been excluded and the remainder of the survey is the subject of a dispute between the British Medical Association’s General Practitioner Committee and the Department of Health because of disagreement over some of the proposed access questions. The dispute has led the GPC to advise GPs not to take part in the survey, even though this could cost GP practices thousands of pounds this year in payments related to the access DES.

DH proposals to use a patient survey to measure choice have always been criticised by GP representatives who have claimed it would mean GPs’ income would be subject to patients’ memories. A national survey already conducted by the DH found that only 30% of patients recall being offered a choice of hospital on referral with as many as 80% of patients in some PCTs claiming they were not offered a choice of hospital (see EHI PRimary Care, 27 September,  ‘Patients cannot remember C+B referral options’).

Guidance from the GPC to GPs on The Patient Experience Survey (PES) adds: “Due to technical reasons, the ‘Choice’ component of the survey cannot be delivered as originally planned. This is because it is not possible for the ‘choice’ question to be answered from a list of patients derived from an individual practice computer as not all referred patients would have been eligible for the survey. Other options are currently under consideration for the 2006/07 PES that will meet this objective. Discussions are continuing between NHS Employers and the GPC on this matter.”

A spokesperson for the BMA told EHI Primary Care: “For logistical reason it wasn’t possible to include questions on choice so we are now looking at alternative ways of getting the information.”

The GPC says the possible use of the Patient Experience Survey to ask questions about choice in future years is subject to negotiations. However it adds that if choice is to be measured in this way, the DH has proposed introducing an administrative Read code that could be used by GPs when making referrals where choice is appropriate to identify patients that could participate in the survey.

Useful links

GPC guidance on the Patient Experience Survey