Written evidence from Doctors.net.uk (CFI
37)
Following a meeting between Doctors.net.uk (DNUK)
and the Rt Hon Stephen Dorrell MP (SD) on 25 January 2011, SD
indicated interest in doctor opinion on a number of areas relevant
to the follow up inquiry.
OVERVIEW
This document summarises the key findings from a
regionally representative online survey of 817 GPs practising
in England, carried out by medeConnect Healthcare Insight on behalf
of Doctors.net.uk. The fieldwork was conducted from 16 to 23 February
2011 and participants are known to be GMC-registered members of
the Doctors.net.uk community. (Further analysis and interpretation
of the data is available on request, plus, see the attached ppt
slides of tabular research results)
The key areas explored were as follows:
1. GP opinions on accountability - both financial
and clinical
2. GP opinions on the priorities for GP consortia
and the impact on the range of services commissioned
3. GP opinions on regional boundaries under the
new commissioning arrangements
4. Opinion on patient choice of practice, outside
their area
5. Financial viability of hospitals
SUMMARY HIGHLIGHTS
1. For clinical issues most GPs feel that they
will have the highest levels of accountability to their GP consortium
(62%), their patients (62%) and their GP practice colleagues (59%).
2. With regards to financial issues, 70% of GPs
say that they will feel a high level of accountability to their
GP consortium, but only 41% say they will feel a high level of
accountability to the NHS Commissioning Board and only 20% to
the NHS Chief Executive.
3. Virtually all GPs surveyed think that consortia
should focus on quality of outcome as the top priority (when presented
with a range of items to rank excluding cost).
4. However, 64% of GPs also believe that GP-led
commissioning will "very much" focus on cost and the
majority of the sample think that this will lead to a restriction
on types of procedures commissioned (61% very likely, 89% likely).
5. Most GPs do not think it is a high priority
for a consortium to commission services from providers in the
same geographical boundaries of the consortium.
6. 67% of GPs do not agree that patients should
be able to choose a GP practice away from their normal area but
most GPs only expect less than 5% of patients to take up this
option.
7. 64% of GPs think that the reforms will lead
to increased utilization of private sector providers.
8. 50% of GPs say that they think the reforms
will have a "major impact" on the financial viability
of their local hospital.
1. GP OPINION
ON THEIR
OWN ACCOUNTABILITY
FOR CLINICAL
MATTERS
Q1. Focusing on clinical matters, to what
extent do you feel that you will be accountable to the following
(once GP-led Commissioning has been fully introduced):
Base: 817
— For
clinical matters, GPs feel the highest level of accountability
will be to their patients, their Consortium and their colleagues
(with 62%, 62% and 59% respectively selecting the "high level
of accountability" option for these three). In contrast,
the lowest level of accountability will be to local government/local
authority and NHS Hospitals (with >50% selecting the low or
no accountability options).
— Clinical
accountabilities to other entities (Care Quality Commission, NHS
Commissioning Board, Department of Health, Monitor and NHS Chief
Executive) were rated between the two extremes, in descending
order from the Care Quality Commission to the NHS Chief Executive.
2. GP OPINION
ON THEIR
OWN ACCOUNTABILITY
FOR FINANCIAL
MATTERS
Q2. Focusing on financial matters, to what
extent do you feel that you will be accountable to the following
(once GP-led Commissioning has been fully introduced):
Base: 817
— For
financial matters, GPs feel the highest level of accountability
will be to their Consortium and then to their colleagues (with
70% and 50% respectively selecting the "high level of accountability"
option). Once again, the lowest level of accountability will be
to NHS Hospitals and their local government/local authority (with
>50% again selecting the low or no accountability options).
— Financial
accountabilities to other entities (NHS Commissioning Board, Department
of Health, patients, NHS Chief Executive, Care Quality Commission
and Monitor (Independent Regulator)) were rated between the two
extremes, in descending order from the NHS Commissioning Board
to Monitor (Independent Regulator).
3. PROPORTIONAL
DIFFERENCES BETWEEN
AVERAGE PERCEIVED
ACCOUNTABILITIES
Q1/Q2. Focusing on [Q1: clinical/Q2: financial]
matters, to what extent do you feel that you will be accountable
to the following (once GP-led Commissioning has been fully introduced):
Bases: 817
— Comparing
the two sets of accountability results, GPs have indicated that,
in terms of the balance between clinical and financial accountabilities,
they believe that the accountability to their patients, the Care
Quality Commission, NHS Hospitals and colleagues will be weighted
more to clinical issues - and that the accountability to most
of the official bodies (Department of Health, NHS Commissioning
Board, NHS Chief Executive and local government/local authority)
will be weighted more to financial issues.
4. BOUNDARY ISSUES
Q3. Please rank the following in terms of
the priority that you believe your consortium a) should follow
when commissioning elective services, and b) will probably follow
when commissioning elective services:
Base: 817
— Overall,
GPs are predicting that consortium priorities will mostly mirror
the GPs' preferred priorities - with "quality of outcome"
leading the way as the highest priority. However, in practice,
GPs suspect that there will be less emphasis on the "quality
of outcome" and on "patient preference" than they
would ideally like to see, and more emphasis on the location of
the service being within the consortium boundary.
5. FOCUS ON
COST
Q4. To what extent do you think that GP-led
commissioning will focus on cost?
Base: 817
— The
overwhelming majority of GPs (91%) believe that GP-led commissioning
will focus on cost (with nearly two thirds (64%) indicating that
the focus will be "very much" on cost).
6. WHAT THE
FOCUS ON
COST LEADS
TO
Q5. If it transpires that GP-led commissioning
does actively focus on cost, to what extent do you think that
a focus on cost will lead to the following:
Base: 817
— Overall,
GPs expect that an active focus on cost will lead to different
types of restrictions (and possibly preventions) - along with
a reduction of patient choice. For example, a very large majority
of GPs indicated that an active focus on cost is likely to lead
to a restriction on the type of procedures commissioned (89%),
a restriction on hospital referrals (87%), a restriction on the
number of procedures commissioned (84%) and an overall reduction
of patient choice (83%). The prevention of hospital admissions
was deemed to be the least likely overall, but even so, 60% of
GPs thought that it would be likely to happen (if there was an
active focus on cost).
7. LIKELIHOOD
OF PATIENTS
CHOOSING PRACTICE
AWAY FROM
NORMAL AREA
Q6. To what extent do you agree with the following
statement?
"Patients should be able to choose a GP practice
away from their normal area"
Base: 817
— Two
thirds of GPs (67%) made it clear that they do not believe that
patients should be able to choose a GP practice away from their
normal area. In contrast, only one in six (17%) expressed agreement
- and only 2% said that they strongly agreed with this principle.
8. HOW MANY
WILL ACTUALLY
CHOOSE
Q7. What proportion of the patients registered
at your practice do you think will actually choose to switch to
a GP practice elsewhere?
Base: 817
— A wide
range of answers were given - from 0% (by 86 respondents) to 30%
(by just one respondent), resulting in an average figure of 5%
(for both mean and median). Indeed, given the strength of feeling
on the subject, it is perhaps surprising that more than three
quarters of GPs (77%) think that 5% or fewer of their patients
will actually choose to switch to a GP practice elsewhere.
9. RURAL AREAS
Q6. To what extent do you agree with the following
statement?
"Patients should be able to choose a GP practice
away from their normal area"
Base: 817
— A higher
proportion of GPs working a rural area (78%, cf 67% overall) are
opposed to the idea that patients should be able to choose a GP
practice away from their normal area, and a higher proportion
of GPs in an urban area (21% cf 17% overall) are in favour of
it.
— In
contrast, rural area GPs predict the lowest uptake (an average
of 4% of patients) and urban area GPs foresee the highest level
of switching elsewhere (an average of 6% of patients).
10. COMFORT DISCUSSING
PATIENT CARE
WITH SECONDARY
CARE COLLEAGUES
Q8. With regards to discussing patient care
matters with secondary care doctors under the new GP-led commissioning
system, please rate how comfortable you think that you will be
(as compared with how you've felt under the old system) in the
three different situations outlined below.
[A: Very likely to commission their services, B:
Neither likely nor unlikely to commission their services and C:
Very unlikely to commission their services]
Base: 817
— Nearly
two in five of GPs (39%) indicated that they would feel less comfortable
(than under the old system) if they were discussing patient care
matters with secondary care doctors that they were unlikely to
commission. In contrast, a notably lower proportion (28%) indicated
that they'd feel more comfortable (under the new GP-led commissioning
system) if they were discussing patient care matters with secondary
care doctors that they were likely to commission.
11. PRIVATE PROVIDERS
Q9. In terms of the future usage of NHS or
private providers for hospital services, which of the following
do you think will be the most likely outcome of the proposed reforms?
Base: 817
— Nearly
two thirds of GPs (64%) predicted that the proposed reforms will
lead to the increased usage of private providers (whereas only
12% predicted increased usage of NHS providers).
12. IMPACT ON
FINANCIAL VIABILITY
OF LOCAL
HOSPITALS
Q10. What, if any, impact do you think the
reforms will have on the financial viability of your local hospital?
Base: 817
— Only
a very small minority of GPs (4%) think that the reforms will
have "no impact" on the financial viability of their
local hospital. In contrast, a third of GPs (34%) are of the opinion
that the reforms will have a "minor impact on viability (which
could involve some cost cutting)", and 50% believe that the
reforms will have a "major impact on viability (which could
involve significant changes in service provision)".
February 2011
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