Dear NHS England,
On 10 September 2013 I sent you a complaint, and have received your reply (see below).
I do not feel that this reply in any way addresses the substance of my complaint [my complaint was a copy of my first email to Jeremy Hunt]. The reply is largely a description of the structure of the choice of GP practice pilot. Whilst I did mention this pilot in my complaint, the substance of the complaint relates to the policy that the pilot is allegedly testing. I have criticisms of the pilot itself, but these are just part of an overall critique.
You mention the evaluation of the pilot carried out by Professor Nicholas Mays and his team. I have been in touch with Professor Mays and have seen his Proposal regarding the evaluation (but not the report which I am told is confidential). The scope of the evaluation does not include an evaluation of the policy itself; the rationale of the evaluation contains some quite questionable assumptions. I will return to this at another time [click here for my post on this issue]. I hope I will be able to see the report.
I would like you to try again with my complaint. I would suggest that you read my Submission to the Health Select Committee (reference number 5 in my email to Jeremy Hunt below; I am attaching it as a document to this email).
In summary, my complaint is as follows:
1. Good quality British general practice is a complex technology which delivers service to a local population. Its ecology is a local one. In our experience, people who move away and live at a distance from the practice receive poorer care; moreover, attempts to deliver care to people who live at a distance is inefficient, and at times unsafe. Distance is a barrier to care.
2. Much of what we do on a daily basis works because it is local. Were it not local, it would not work.
3. There is then an added problem, that of capacity. Our practice is unable to register all the patients who want to register with us from within a relatively small practice area. We are currently working beyond our capacity, and this drives down the quality of our service in terms of access and the time we can spend with patients, especially those with complex needs. We are not alone in this: almost all practices are working beyond their capacity limit. They simply will not have the space to look after additional patients (who would then bring with them the added problems of living at a distance from the practice mentioned above).
4. The politicians who have promoted this policy have simply ignored what I have outline in nos. 1-3 above. They have not undertaken an honest risk assessment.
5. Worse still, the Department of Health has not undertaken an honest risk assessment. They too have presented this policy in an idealised ‘rose tinted’ way, glossing over the very real problems inherent in a geography-free model. I am saying that they have been very misleading and dishonest.
So I would ask for a robust response to the issues I am raising, not written by some ‘customer relations’ worker who clearly does not have an understanding of the issues.
1. Please deal with the issue of distance from the practice. Does NHS England understand the risks of distance from the practice? (see my submission to the Health Select Committee, with back up documentation in the form of references).
2. Please respond to the issue of capacity. (Again, see my Submission to the Health Select Committee).
3. The Department of Health mentioned the ability for a child to be registered with a GP practice near his/her school (in the press release of December 2011 announcing the pilot, and it appears again in Professor Mays’ Proposal, as one of the rationales for the policy). Can you please tell me a. what benefit accrues to a child and parents with such an arrangement?; b. how would this work from a practical point of view? (yes, please spell it out); c. what are the possible risks or problems with this arrangement?
4. Please respond to the problems with visiting patients who are not registered with a local practice. Again, see the relevant paragraph in my Submission to the Health Select Committee.
Many thanks for your help.
The Tredegar Practice
35 St Stephens Road
[26/8/14: The above was sent to NHS England in December 2013; I have received no reply at all.]
Reply from NHS England 26/11/13
Dear Dr Farrelly,
Re: Complaint reference SDR136238
Thank you for your e-mail of the 10th September 2013 raising your concerns regarding the choice of GP practice pilots.
I have been in touch with the GP contracting team in the NHS England Commissioning Development directorate who have provided me with some expert advice on this matter in order to enable me to provide you with an appropriate response to your concerns.
As you will know In April 2012, the Department of Health agreed a 12 month variation to general practice contracts giving patients a right to choose to register with any GP practice participating in the pilot without being restricted by the practice boundaries previously agreed with Primary Care Trusts. The pilot allowed patients to access GP practices beyond the areas in which they lived, in four participating PCTs (Westminster, Salford, Manchester and Nottingham City). It was expected that the pilot would benefit patients by giving them more freedom, choice and control over where they accessed care. It also included an option for patients to be seen as ‘day patients’ without registering.
The pilot scheme operated until the end of March 2013 although patients who have registered with a participating practice have been able to remain with that practice while the scheme is being evaluated in order to ensure that continuity of care is provided.
The scheme is being evaluated by the Policy Innovation Research Unit at the London School of Hygiene and Tropical Medicine and their final report is due during November 2013. Any proposals for changes to the GP contract to extend patient choice following consideration of the evaluation report would be need to be discussed with the BMA’s General Practitioners’ Committee.
We are anticipating that any issues relating to home visiting and access to community services will be highlighted from the evaluation and can then be addressed while considering the evaluation in its entirety.
I hope that this has answered your questions with regards to this matter. If you have any further concerns or questions relating to this matter please do not hesitate to contact us at firstname.lastname@example.org, or by calling 0300 3 11 22 33. Please do not reply directly to this email.
Jane Doe (name changed to protect the innocent)
Customer Contact Centre Case Officer
PO Box 16738, Redditch, B97 9PT
0300 3 11 22 33