Promoting improved access through the GP contract

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Abstract

In 2004 the Government introduced an financial incentive scheme that rewards general practitioners (GPs) for providing good patient access to their services. A principal aspect of 'access' in this context is the opportunity for patients to 'choose and book' their appointment, and GP performance is assessed on the basis of patient surveys. This report describes the payment mechanism and summarises the results of the 2007 patient survey.

Recent developments

In 2007, the Government commissioned a survey, which in its entirety was given to around 5 million people in the hope that they would return the survey by post, to assess their views on how quickly they were able to book an appointment with their GP, whether they discussed choice (the choice survey applied to a subgroup of the 5 million), and whether they were satisifed with their GPs' opening hours. The survey was run by Ipsos MORI and cost about £11 million. The survey results were released in the middle of 2007, and the results were used to give financial rewards to 'good performing' practices, with the first financial payments being made in the first quarter of the 2007-08 financial year. GP practices were given the option of opting out of the scheme, on the understanding that they would, of course, forgo any financial incentives associated with it. 

The financial incentives work as follows. In the survey, the respondent reports whether, on visiting their GP, they had a discussion about choice of provider. If, for any particular GP practice, 60% or more of the practice's patients wrote that they had had such a discussion, the practice recieves a payment of 48p per patient. The practice receives an additional payment of 48p per patient if it makes a written commitment to ensure that choice is made available to the patient. However, any practice that makes this written commitment but then fails to achieve the '60%' threshold, has to repay the payment that was conditional on their written commitment.

A national budget of £1.5 million has been allocated to this programme nationally, so, on the grand scheme of things, it's not much. The money is distributed by weighted capitation to PCTs, who then 'pay' the practices over which they have jurisdiction.  

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral
current    previous

My reservations about the whole choice agenda in NHS policy are clear in previous reports, not least because of the eventual strain that this direction may put on NHS finances. Also, the 'value for money' of a survey aimed at 5 million people, and the validity of postal surveys, can be questioned. But if the figures are to be believed, it seems as though GPs respond reasonably well to financial incentives, which may prove to be a cost-effective way of improving the responsiveness of the NHS. 

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Initiators of idea/main actors

• Government

• Providers

• Patients, Consumers: Quite high number of responses to the survey, so must like to be asked these types of questions

Stakeholder positions

The Central Government are clearly supportive of the initiative, because it's their policy development. GPs have done very well out of the GP contract generally, and have already demonstrated that they respond very well to financial incentives. Although the total payment from this particular incentive is not huge, seemingly averaging about £6000 per (successful) practice per annum, the results suggest that most GPs are discussing choice with their patients (see below), although it may have of course been the case that GPs would discuss choice with their patients with or without the financial incentives. The number of responses was quite high, on the whole, so patients/the public probably like be asked for their opinions and experiences about these sorts of mattters, perhaps because they see the NHS as an important part of British society.

Actors and positions

Government
Central government	very supportive		strongly opposed
Providers
GPs	very supportive		strongly opposed
Patients, Consumers
GP patients	very supportive		strongly opposed
current    previous

Influences in policy making and legislation

The policy is implemented and on-going. This section is not applicable.

Legislative outcome

n/a

Actors and influence

Government
Central government	very strong		none
Providers
GPs	very strong		none
Patients, Consumers
GP patients	very strong		none
current    previous

Positions and Influences at a glance

Adoption and implementation

I think this is all explained above. The main development, I suppose, is that the Government is relying on patient report data to some extent to see if their choice policies are being practiced by GPs, and are giving GPs financial incentives to respond to these policies. Financial incentives are becoming an increasingly important part of health policy in the UK. The Government is currently considering using financial incentives for patients to encourage them to adopt healthier lifestyles as an attempt to tackle the 'obesity crisis'. These forms of incentives are likely to form a topic of future Health Policy Monitor reports, if requested. 

Monitoring and evaluation

The main results from the 2007 survey were that 2,295,987 people, while 269,301 responses were received from the choice survey. Quoting directly from the summary of the survey, "86% of people reported that they were satisfied with their ability to get through to their doctor's surgery on the phone, 86% of people who tried to get a quick appointment with a GP said they were able to do so within 48 hours, 75% of people who wanted to book ahead for an appointment with a doctor reported that they were able to do so; 88% of people who wanted an appointment with a particular doctor at their GP surgery thought they could do this, 84% of people said they were satisfied with the current opening hours in their practice and 94% of people who were referred by a GP discussed choice of hospital." It appears to be the case, therefore, that most GPs are indeed discussing choice with their patients, and are therefore in receipt of the incentive payment.

Expected outcome

It appears that financial incentives are probably working, assuming that it is these that are encouraging most GPs to discuss choice with their patients. If the results of the survey are to be believed, access to GPs services, as measured through the various questions in the survey, appears to be quite good. I would not expect these figures to worsen significantly, unless the financial incentives scheme is stopped.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high
current    previous

I have nothing really to add at this point.

References

Sources of Information

Department of Health. GP patient survey: your doctor, your experience, your say: guidance for strategic health authorities, primary care trusts and GP practices. Department of Health: London 2006.

Department of Health. GP patient survey: your doctor, your experience, your say: further guidance for strategic health authorities, primary care trusts and GP practices. Department of Health: London 2007.

Department of Health. GP patient survey 2007: national results. Department of Health: London 2007.

 

Reform formerly reported in

Remuneration: New Methods for Paying Doctors Process Stages: Implementation, Policy Paper, Idea

The new GP contract Process Stages: Implementation, Policy Paper, Legislation, Idea

Updating the GP contract Process Stages: Implementation, Evaluation

Author/s and/or contributors to this survey

Oliver, Adam

Suggested citation for this online article

Oliver, Adam. "Promoting improved access through the GP contract". Health Policy Monitor, April 2008. Available at http://www.hpm.org/survey/uk/a11/3