Choice surveys to be given to referred patients

Tags: booking Choice Choose and Book DH GP GPs PCTs

16 Jan 2007

GPs taking part in the choice and booking incentive scheme are expected to hand out surveys from the beginning of this week to measure the percentage of patients offered choice at referral.

Practices must hand the questionnaire to all patients where an eligible referral is made between 16 January and 30 March 2007 and patients can then return the survey to research company Ipsos MORI in a reply paid envelope.

Distributing surveys via practices is expected to be an interim arrangement for this year because it was not possible to include the choice question in the access to GP services survey also being conducted by MORI. However it is intended choice questions could be included in an access survey from next year.

The choice component of the directed enhanced service (DES) is worth 48p per patient to practices of which half has been paid in advance as an aspirational payment to those agreeing they would offer choice.

Primary care trusts (PCTs) must arrange for repayment of the aspirational payment, or offset the repayment against other income due to the practice, if less than 60% of patients agree they were offered a choice of provider.

The survey mechanism for the DES has been consistently criticised by GPs who claim their income will be dependent on patients’ memories. The Department of Health’s own bi-monthly surveys on choice this year have so far shown only about 30% of patients recall being offered choice at referral.

The DH has also issued guidance to PCTs on measuring the e-booking component of the DES. The guidance says PCTs are responsible for assessing and making payments to practices.

It says information on total number of referrals made by practices is available in waiting list returns and information on referrals via Choose and Book is collected by the Choose and Book system.

Frequently asked questions addressed by the guidance include:

• what happens if a practice generates a unique booking reference number (UBRN) which is not converted,

• what counts as a referral,

• what happens if a booking is subsequently cancelled and

• what happens if the Choose and Book system is not working.

On this point the guidance says: “If, by the end of 2006/07, a practice has not been able to implement Choose and Book due to circumstances beyond its control (e.g. due to national or regional difficulties), the commitment to award payment to practices will still hold and the practice should receive a pro-rata payment for the work that they have completed. This payment is to be decided by the PCT.”

Payments will be made to practices on a sliding scale for practices achieving between 50% and 90% of referrals electronically between 1 September 2006 and 28 February 2007. Only about a third of referrals were being made through the system nationally by the end of December. Practices not achieving the minimum 50% threshold will have to pay back their aspirational money.

Links

Briefing on choice of hospital survey

DH Guidance on Choose and Book payments

Reader's Comments

What a dog's dinner!

mary.hawking@nhs.net

16 Jan 07 21:01

As far as I can see, every mistake possible has been made in the design of these patient "surveys"! Take the question of patient choice. We are being asked to give patients a survey questionaire at the time of referral. Obviously all patients will be handed a Choice Leaflet designed by the DH for distribution by the PCT. Is this a method to make sure that all patients do recall that they were offered "choice"? (nice change if so: makes me wonder about the underlying motivation...) It is unfortunate that many possible "choices" will not be available because hospitals are refusing to take any referrals until they have reduced possible conflicts with 18 week targets. Choice? well, yes - but no obligation on Trusts to ensure that the chosen hospitals are willing to provide any services... this sounds more like rationing to me.

Many Hospital Trusts seem to have great difficulties in organising any access to C&B referrals - or, indeed, toagreeing what is suitable for referral via C&B. Locally, they will not handle 2 week or urgent referrals via C&B: this will certainly reduce my practice's ratings - and as appointments are not directly bookable, adds to patient frustration - especially when the referral comes back marked "this speciality is closed to referrals".

I agre that this is brilliant planning on the part of DH: agree a service which is to be funded - and then arrange it so that there is no way that the agreed service can be delivred (if the nightmare scenario comes up that it might be achieved arises, think laterally - CHANGE THE RULES AT THE LAST MOMENT - you know it makes sense and has now become a standard tool... The thing to be avoided at all costs is any transparency which might reveal the machinations of DH - just think of the savings to be made by ensuring that contracted services cannot be delivered because of the failures of CfH: could this be the reason for all the failures? Clunky software for C&B (including the inability of the software to deal with Java upgrades)? the release of a major redesign of the rule set for QOF in December 2006 - leaving less than a quarter of the contract time to perform the services required?

There are numerous examples

DH is out to destroy general practic: I rest my case

An excellent summary

18 Jan 07 18:01

The comment above says it all. Government wants to prove it is offering choice, which it has made impossible, so bribe GPs to hand out choice leaflet and survey together 'the Government is checking that you have been offered a choice. We have agreed you wish to go to the local trust, but in the booklet here you will see the other sites you could have gone to, just complete this on your way out and our receptionist will post it for you'

Make the system so slow it is too exasperating to use, knock out access to the website every few days, under resource the local trusts so that directories are rarely populated with appointments, and then just when they think they might be getting the hang of it, take away all appointment slots on line to make sure no-one tries to book outside the 11 week delay put in by the PCT.

How is a practice to prove that making sufficient electronic bookings to qualify for the Direct Enhanced Service payment was an impossibility, no matter how hard they had tried to persevere?