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Health: GP Services

Volume 694: debated on Tuesday 24 July 2007

My right honourable friend the Secretary of State for Health (Alan Johnson) has made the following Written Ministerial Statement.

General practitioners in England are among the best in the world. A recent international survey by the Commonwealth Fund showed that the United Kingdom stands out as a clear leader in providing the right incentives for high-quality care. I know from my conversations with GPs that many are aware of the need to continually improve services in response to rising public expectations.

In some places, however, patients find it difficult to get an appointment with their GP at a convenient time. For some patients, having a GP surgery that is open only when they are at work is a great inconvenience. In other cases, the ease and convenience of booking or gaining repeat prescriptions could be improved. In some areas, particularly the more deprived, there are fewer GPs and GP services than patients could rightfully expect.

These are major challenges for the 21st century National Health Service as it seeks to improve in response to the rising expectations of patients—expectations of both convenience and quality.

The patient survey of GP services, undertaken between January and March 2007, is the largest ever survey of patients regarding the primary care services they receive. Over 2 million responses were received, giving us a major insight into patients’ views of access to GP services. The survey will be used to inform the Government's longer-term primary care strategy.

The survey shows that many patients report a good experience of GP services. This is a testament to the hard work and dedication of GPs, primary care nurses and other practice staff. The survey shows:

86 per cent of people were satisfied that they could get through to their doctor's surgery on the phone;

86 per cent of people who tried to get a quick appointment with a GP were able to do so within 48 hours;

75 per cent of people who wanted to book ahead for an appointment with a doctor reported that they were able to do so;

88 per cent of people who wanted an appointment with a particular doctor at their GP surgery could do this;

84 per cent of people were satisfied with the current opening hours in their practice; and

94 per cent of people who were referred by a GP discussed choice of hospital.

The summary report has been placed in the Library, and the full results of the survey can be found at

Practices that offer an accessible service that patients are satisfied with will now receive a payment triggered by the survey results; practices with dissatisfied patients will not. Around £100 million in GP income is linked to the survey results, providing a clear incentive for increased responsiveness.

Of those patients not satisfied with the current opening hours in their practice, 46 per cent said they wanted the practice to open on a Saturday and 26 per cent said they wanted the practice to open on a weekday evening.

In addition, people from minority ethnic communities, particularly Bangladeshi and black African groups, were more likely to be dissatisfied with a range of GP services than their white counterparts. There are marked differences in satisfaction between different ethnic groups:

black/black British people and Asian/Asian British people had satisfaction rates around 5 to 10 per cent below white British people; and

people from a Bangladeshi background have lowest levels of satisfaction (around 20 per cent below white British people).

In addition to the concerns raised in the survey, we also know that there is a persistent problem of insufficient doctors in the most deprived areas. For example, last year Barking and Dagenham had 43 GPs per 100,000 population while Northumberland Care Trust had 88; the England average is 61.

The world-class services celebrated in international surveys should be available to all patients in all communities. Good primary care services mean different things to different people therefore services must be sensitive and responsive to patients' needs.

Lord Darzi’s NHS next stages review will look at these issues in detail and make its first, interim report in October 2007, setting out the route by which the NHS of the 21st century will offer a service which meets the needs of modern patients living busy lives. However, in some areas highlighted by the survey, we can make faster progress, and I am announcing five measures today to begin this process:

I will ensure that primary care trusts (PCTs) analyse this rich data and produce robust local action plans to address concerns expressed by patients. These will be made available to the NHS next stages review, in which I am asking PCTs to actively engage. They will show how PCTs can use existing powers to make rapid service improvements in GP services by the end of this year;

patients tell us that they want better information about their own and other GP practices. We will publish new practice data on the NHS choices website, covering practice opening hours and available appointment times, indicators of the quality of care and what extended services the practice offers. This will be an important first step in improving the information available to patients;

I am establishing a national improvement team, led by the national clinical director for primary care, David Colin-Thome, who was a highly respected practising GP for over 35 years. This team of experts will give targeted support to poorly performing PCTs and practices to improve access. Their initial focus will be on the areas with the lowest patient satisfaction and fewest doctors per head;

I have also asked Professor Mayur Lakhani, the chair of the Royal College of GPs and a highly respected practising GP, to look at the complex issue of why primary care services are not currently meeting the needs of people from black and minority ethnic communities. He will work closely with the Darzi review in advance of recommendations to tackle these inequalities later this year; and

the publication of the survey results releases some incentive payments to GPs who are rated very highly for access. To ensure that services continue to improve, I have asked Lord Darzi, through the NHS next stages review, to work with the BMA to review the current incentives for GP services (the QOF). Lord Darzi will consider the potential for GPs to be asked to achieve even better outcomes for their patients in order to earn the same level of incentive. In particular, Lord Darzi will look at how QOF can reward responsiveness to patients’ experience in a more effective way, addressing local issues and concerns.

I expect practices with low satisfaction rates to make substantial improvements as a result of these measures. My department has already agreed a new performance indicator with the Healthcare Commission that uses data from the patient survey. This will ensure that low-scoring PCTs that do not make the improvements that their patients want to see will have their ratings marked down.