The Rantings of a Practice Manager

The survey is dead. Long live...ummm....not sure really

2010-06-23T22:54:00.005+01:00

Up and down the country there was almost unanimous joy in GP land at the announcement of Andrew Lansley to deliver a death blow to the highly controversial and widely hated patient survey. I for one have many concerns with it's accuracy and find that it was by far a perfect tool by which to judge GPs. It is easy to dismiss the survey as non representative and claim that it is not a true marker of patient satisfaction however one has to admit that as yardsticks go the national GP patient survey gave us a strong indication of our strengths, weaknesses and a general overview of how we compared to the rest.

It's all good and well claiming that the survey stresses to much on access but can we really claim that it hasn't made us all think a bit more about appointments, waiting times at the practice, striking a better balance between same day and advance appointments? If we look at some of the proposals being put forward to replace the survey we can clearly see they are just as liable in presenting an inaccurate view of our practices, such as the call to reinstate local health watch committees or local based surveys.

Instead of doing away with the survey why did we not try and fix it, we all know about the problems raised regarding small sample sizes, disregarding ethnicity in weighting the results despite this being a major factor as shown by credible research published by the BMJ. My concern is that we risk throwing out the good with the bad instead of assessing each thing on it's merit.

How do referral caps fit in with patient choice?

2010-05-12T13:46:00.002+01:00

In recent weeks many of us practice managers have been sent guidelines of new referral processes for our respective areas. In essence these processes are aimed at reducing referrals into secondary care by either managing referrals before they reach the hospital consultants by an intermediary service or by setting a quota on referrals. These policies appear to be diametrically opposed to patient choice.

Can you imagine a GP having to weigh up whether they should refer a patient not based on clinical need but on whether they have used up their quota. It also does not sit comfortably with me that every referral (oh sorry not the urgent ones) have to go through an intermediary, correct me if I am wrong but does this not go smack in the face of patient choice, only a year ago at the time of unveiling the NHS constitution we were told that patients had the right to be referred to their provider of choice. How can a GP now book a patient via choose and book at their hospital and time of choice if they have to jump through these new hoops?

Leaving aside our opinions about patient choice for a minute, why can we not stick to a policy for more than a month without changing it? Has anyone ever calculated the cost of distruption everytime a change of focus is decided?

We all have a role to question and challenge any change of policy being presented, at the end of the day it is those at the coal face who really know what matters to patients.

Will Scrapping Practice Boundaries Improve Patient Care?

2010-05-06T12:43:00.001+01:00

All the major political parties have made it patently clear that they are intent on removing practice boundaries which is no surprise given it is such an election grabbing policy. On paper it sounds excellent, remove practice boundaries and give patients the choice to register wherever they want. However the problem with any headline grabbing policy is in the detail and this is where this policy falls flat on its face.

There are three broad problems with this proposed policy. These are responsibility of home visits, organising community services and lastly funding.

1) Who picks up the responsibility of home visits?

This is the first and main stumbling block of the proposed policy. As we all know as things stand the patient's registered practice is responsible for home visits at all times and the way this has naturally been managed is through reasonable practice catchment areas, i.e. none of us would register patients 20 miles away (except maybe for some very rural practices) as we simply know we could not conduct home visits. However over the years most of us could probably give a few examples of patients who would have liked to remain registered with us despite the long distance, but the real problem here is that these are the patients with the most medical demands, i.e. long term chronic disease patients, possibly palliative care patients staying with relatives etc. The consultation being carried out by the government puts forward the following options with regards to who should be responsible for organising home visits:

a) the patient's registered practice, regardless of the distance from the patient's home

b) the local PCT of the patient's home address should be responsible for commissioning this service (possibly by paying for each home visit done)

c) patients could be allowed to have two concurrent registrations, i.e. one registration with your preferred GP and another one primarily for home visits close from home

All three of these options present their own logistical problems and are undoubtedly going to put yet greater burden on already stretched NHS resources at a time when we we are being told to tighten our belts.

2) Organising community services

Organising community services for patients living far from their registered practice presents a similar if not more complicated logistical problem than home visits. We all know the stark differences in the provision of community services, i.e. some areas operate a Community Assessment Unit (CAU), while others rely more heavily on the local HART team, it is safe to say that community services vary greatly across the board from chiropody to social services. We all find a way of operating in our local area and know when and how to get things done, such as a quite word with a PCT manager to get things moving if we can't get the district nurses to visit one of our patients. I'm sure a GP in Southend will be able to get the McMillan nurses in Lewisham to arrange regular support to one of their patients, but at what cost and stress to all involved?

3) Cost to the NHS

It is pretty clear that a logistical change of this magnitude is going to create an additional cost which was simply not there. This will mainly come in the form of commissioning additional services for home visits, community services and Out of Hours cover. It is also conceivable that a dual registration will be introduced which simply means two GP surgeries will be paid for looking after the same patient. At a time when we talk of consolidating local resources to offer an excellent local service to our patients with the introduction of 'Darzi' centres why o why are we talking of removing practice catchment areas.

It seems we are being forced to implement a solution to a problem which never existed. However we shouldn't take this lying down, we have an opportunity to voice our concerns via the DH consultation which you can access on the link below and raise concerns via the various channels we have such as the BMA, GPC, RCGP, LMCs and other GP leaders:

http://www.gpchoice.dh.gov.uk/