Media Summary Results from the Doctors.net.uk omnibus
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Media Summary
Results from the
Doctors.net.uk omnibus
At the centre of the Government’s NHS White Paper, Equity and Excellence:
Liberating the NHS is the proposal for GP-led consortia to take over
responsibility for commissioning the majority of NHS services in England,
with primary care trusts (PCTs) due to be abolished by April 2013. All GPs in
England will be required to join one of the consortia, which will assume their
new statutory responsibilities by 2013/14.
To explore the views of GPs on the emerging reforms, we in partnership with
the UK’s largest professional network of doctors, Doctors.net.uk, present
here the results of two omnibus surveys of the website’s GP members, all of
whom are registered with the General Medical Council. The surveys were
conducted in January and February 2011. The sample consisted of a large,
regionally representative group of GPs (see methodology for full details).
The results shed further light on the preliminary arrangements many GPs are
making among themselves, their expectations of how consortia will work,
and the types of support they believe GPs will need to discharge their new
duties successfully. This media summary highlights some of the main
findings from the survey. The underlying data are available to download from
our website at http://bit.ly/NT_Projects_NHS_Reform.
For more information on our work programme and to sign up to receive our regular e-newsletter,
visit www.nuffieldtrust.org.uk
Methodology
Each month medeConnect Healthcare Insight – a division of Doctors.net.uk – undertakes an
omnibus survey of the site’s GP members, all of whom are registered with the General
Medical Council. Pollsters aim for at least 1,000 complete responses. For January 2011 the
completed response rate for the 16 questions was 1,024 (12 were rejected on quality
grounds). However, the nine questions referring to GP commissioning were restricted to
respondents practising in England. The base for this survey is therefore 838. Likewise in
February, 1,002 GPs completed the omnibus, but with only the 817 GP respondents who
practised in England answering the questions on commissioning. The base for the February
survey is therefore 817.
Key findings from the surveys
· Less than a quarter of GPs (23 per cent) agree that the proposed reforms will
improve the quality of patient care provided by their organisation/practice. But GPs
who were more actively involved in commissioning were more likely to think that
quality of care will improve.
· 71 per cent think that the priority for commissioning will focus on cost. Those
actively involved in practice based commissioning (PBC) are more likely to think
this. Overall, GPs expect this is likely to lead to different types of restrictions (and
possibly preventions), along with a reduction of choice, particularly the number and
type of procedures commissioned and referrals to hospital.
· Opinion as to whether the reforms will encourage closer working relationships to
develop between primary care and hospital doctors was highly polarised. Those
actively involved in commissioning think the reforms will encourage better
relationships.
· Only 4 per cent of GPs think the reforms will have no impact on the financial
viability of their local hospital, whereas 50 per cent believe the reforms will have a
major impact on viability.
· Nearly two thirds of GPs predict that the proposed reforms will lead to the increased
usage of private providers (rather than NHS providers).
· Two thirds of GPs oppose the principle of patients being able to choose a GP
practice away from their normal area, despite the majority also believing that only 5
per cent of patients would actually exercise this choice.
· The majority of GPs (61 per cent) agree that there are local leaders in their area with
the capability to lead GP commissioning (strongly associated with GP involvement
in commissioning).
Key messages themes and messages from the survey
States of readiness
Asked to define the status of GP commissioning in their area, 1-in-6 respondents (17 per
cent) to the January 2011 survey indicated that their consortium was fully set up, with 11 per
cent at the stage of finalising plans and 42 per cent in the process of putting the consortia
together (figure 1). When asked more than half of all respondents said they were already
members of consortia (figure 2).
Figure 1
Which of the following best applies to the status of GP commissioning in your area? Base: 838
Figure 2
Are you a member of your area’s consortium? Base: 838
It is difficult to extrapolate from these figures respondents’ attitudes to the reforms. There
does appear however to be a relationship between respondents’ willingness to identify
themselves firstly as a member and then as ‘actively’ involved in commissioning (see
figures 3 & 5) and the stage of development reached by a consortium (Figure 4). It is also
noteworthy that just over half (51 per cent) of respondents envisage a merger of existing
PBC groups in their area (figure 6), with those involved at higher levels most likely to
predict that their consortium will comprise the same members as their existing PBC groups
(figure 7).
Figure 3
In what capacity are you involved in commissioning? Base: 838
Figure 4
Which of the following best applies to the status of GP commissioning in your area?
In what capacity are you involved in commissioning?
Base: 838 (Consortium level=67, PBC level=64, Practice level=166, Not actively involved=526, other=15)
Figure 5
Are you a member of your area’s consortium?
In what capacity are you involved in commissioning?
Base: 838 (Consortium level=67, PBC level=64, Practice level=166, Not actively involved=526, other=15)
Figure 6
Which of the following do you envisage for your area? Base: 838
Figure 7
Which of the following do you envisage for your area?
In what capacity are you involved in commissioning?
Base: 838 (Consortium level=67, PBC level=64, Practice level=166, Not actively involved=526, other=15)
The factors that GPs say will affect commissioning decisions
Under the Health and Social Care Bill, GPs will face a statutory duty to remain in financial
balance (clause 23, section 223I). Survey respondents seemed keenly aware that as they take
on responsibility for commissioning, managing costs will be a crucial consideration, with 91
per cent saying that GP-led commissioning will focus on cost (figure 8). There was a
seemingly widespread view among respondents that this will lead to different types of
restrictions (and possibly preventions) – along with a reduction of patient choice (figure 9).
Geography also features strongly. When asked to rank their priorities for commissioning
elective services, GPs indicated that while quality of outcomes were an important
consideration, they are likely to place much more emphasis on the location of the service
being within the consortium’s boundary (figure 10).
Figure 8
To what extent do you think that GP-led commissioning will focus on cost?
Base: 817
Figure 9
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:
Base: 817
Figure 10
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
Implications of GP-led commissioning for secondary care
Several commentators, including the Nuffield Trust, have suggested that to have an effect on
expenditure and quality GPs will need to work together with specialist doctors in hospitals
and patients to ensure that care is integrated and co-ordinated along a pathway stretching
from home to hospital. There has been some debate recently about whether the renewed
emphasis on competition and ‘any willing provider’ will further hinder integration, while
some senior clinicians have urged their colleagues to seize the opportunity afforded by GP
commissioning to collaborate more closely with their hospital based colleagues.
However, the results of the February survey suggest that some GPs anticipate a more
complex reality, with many expressing discomfort at the prospect of discussing patient
matters with those secondary care doctors that they are unlikely to commission care from.
GPs also appeared divided on the issue of whether the reforms will have an impact on the
financial viability of local hospitals. Four per cent thought they would have no impact, 34
per cent thought they would have a minor impact, while a full half believe they will have a
major impact (figure 11).
Figure 11
What, if any, impact do you think the reforms will have on the financial viability of your local hospital?
Base: 817
Attitudes to patient choice
Echoing last year’s debate over the proposed abolition of GP practice boundaries, the
majority (two thirds) of GPs oppose the principle of patients being able to choose a GP
practice away from their normal area (figure 12), despite the majority also believing that
only 5 per cent of patients would actually exercise this choice (figure 13). Among those
opposed, the highest proportion work in rural practices, while among those in favour, the
highest proportion worked in urban practices (figure 14).
Figure 12
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
Figure 13
What proportion of the patients registered at your practice do you think will actually choose to switch to a GP
practice elsewhere?
Base: 817
Figure 14
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
For further information on the data presented in this briefing
please contact the Nuffield Trust press office on 0207 462 0555
or email pressoffice@nuffieldtrust.org.ukYou can also read
