1. Working Together West Kent CCG Survey to GP Practices Draft Report
Vicky Dyer & Louise Goldsmith Participation and Insight Team, KMCS October 2013

2. Introduction
West Kent CCG asked KMCS to undertake a survey in 2012 in order to obtain GP feedback on CCG communications and engagement with practices
This year a follow-up survey was undertaken and a link to the online survey was sent to all GPs and Practice Managers in West Kent CCG
In responses received with 84% of Practices responding
In responses received with 58% of Practices responding
Respondent’s job title were as follows:
2012
2013
Doctor
79%
67%
Practice Manager
19%
27%
Other 2% 6%

3. Executive Summary - Communication
[1 of 3]
Three quarters of respondents still believe the CCG communicates well with practices.
Respondents still agree (around three-quarters) that the Patch and PCL meetings are useful in informing practices of the board’s concerns and in informing the board of practices’ concerns. The frequency of these meetings is still deemed appropriate.
In 2013, 52% agree that locality managers are helpful in understanding the board’s ambitions and 21% disagree vs. 63% and 8% respectively last year.
In 2013, 43% agree that locality managers help provide practices’ feedback to the board and 23% disagree vs. 53% and 14% respectively last year.
Support for DORIS has improved - over three quarters of users agree that it has improved their access to a wide range of care pathways and clinical information.

4. Executive Summary - Commissioning
[2 of 3]
Around half agree that the board has a good understanding of the commissioning ambitions of local GPs.
Regular communication with all GPs and understanding roles and responsibilities of the board will help GPs and Practice Managers to understand commissioning and meet the needs of the local population better than the PCT did.
This year, 56% don’t feel involved in the commissioning care of patients and 35% do, in line with 2012 results (56% and 39% respectively).
Nearly half are happy to leave commissioning care decisions to an elected board, 5% wish to be fully involved and 50% would like some involvement.
More than half agree that comparing prescribing and referral patterns, and patients’ use of A&E are markers of good clinical care, and comparisons to colleagues are useful in professional development.

5. Executive Summary – Commissioning Decisions
[3 of 3]
Areas identified for service cuts to fund investments in new or enhanced services, include:
secondary care;
reducing bureaucracy;
changes to prescriptions;
enhancing community services to reduce hospital attendances & stays.
Such decisions should be made by vote or by the board, with proposal details sent to GPs in advance for feedback.
There has been a improvement in respondents feelings that the CCG will make decisions fairly and competently.
Most respondents suggested a ‘softly softly’ approach to dealing with overspending practices.

6. Three quarters of respondents believe the CCG communicates well with their practice.
Q.4 The CCG Communicates well with your practice Base: 122 (2012), 70 (2013)

7. Respondents still agree that the Patch & PCL meetings are useful in informing the board of their practice’s concerns
Q.5 The Patch and PCL meetings are useful in informing the board of your practice’s concerns Base: 122 (2012), 70 (2013)

8. Respondents still agree that the Patch & PCL meetings are useful in informing their practice of the board’s concerns
Q.6 The Patch and PCL meetings are useful in informing your practice of the board’s concerns Base: 122 (2012), 70 (2013)

9. The frequency of Patch and PCL meetings remains right for the vast majority of respondents.
Q.7 The meetings should be held more or less frequently Base: 122 (2012), 70 (2013)

10. Respondents are less agreeable that locality managers help their practice to understand the board’s ambitions
Q.8 The locality managers are helpful to your practice in helping you to understand the board’s ambitions Base: 122 (2012), 70 (2013)

11. Respondents were also less agreeable that locality managers are helpful to their practice in giving their feedback to the board
Q.9 The locality managers are helpful to your practice in giving your feedback to the board
Base: 122 (2012), 70 (2013)

12. Support for DORIS has risen with 82% agreeing it has improved their access to a wide range of care pathways and clinical information
Q.10 DORIS has improved your access to a wide range of care pathways and clinical information
Base: 122 (2012), 70 (2013)

13. More respondents agree than disagree that the board has a good understanding of the commissioning ambitions of local GPs
Q.12 The board has a good understanding of the commissioning ambitions of local GPs
Base: 122 (2012), 63 (2013)

14. Around half are unable to tell if services have improved for patients as a result of the CCG
Q.13 The coming of the CCG has improved services for patients
Base: 122 (2012), 63 (2013)
GPs are so rushed off their feet now trying to deal with all the various targets that come out of the CCG and NHS
it’s too early to get a general picture
but not CCGs fault
Most state that it is too early to tell whether the coming of the CCG has improved services for patients
A few felt that services for patients have not been improved because GPs are too busy dealing with targets and increased workload
And a few who felt that the services for patients had not been improved state that this is not the fault of the CCG
Note: new question in 2013 survey

15. I feel patch meetings work one way only
Q14: Given that all GPs will need to share some responsibility for commissioning care for their patients, what can the CCG do to make sure that your views about services are heard and acted on?
Many respondents comment that there is a system in place and some requested that the board should consider more closely the feedback from Patch meetings.
Regular, formal communications from the CCG to keep them fully informed would be beneficial
summaries, with bullet points, rather than lengthy minutes from meetings, which avoid acronyms
the CCG should clearly explain the reasons behind decisions being made
every GP should receive them, rather than just the lead GP in each practice
Some respondents asked that the CCG ensure this communication is two-way and seek feedback and views from GPs and listen and act on the feedback.
Some respondents specifically mentioned using the PLT updates or other face to face meetings.
I feel patch meetings work one way only
Patch meetings enable GPs to provide views to the CCG
Take back our views

16. Over half of the respondents continue to feel uninvolved in the commissioning care of their patients?
Q.15 How involved do you currently feel in the commissioning care of your patients?
Base: 122 (2012), 63 (2013)

17. As before over a third prefer to leave commissioning care decisions to an elected board
Q.16 Going forward what level of involvement would you like to have?
Base: 122 (2012), 63 (2013)

18. Less than half now agree that comparisons of prescribing and referral patterns and patients’ use of A&E are markers of good clinical care
Q.17 To what extent do you think that comparisons of your prescribing patterns, your referral patterns and your patient’s use of A&E are markers of good clinical care?
Base: 122 (2012), 63 (2013)

19. Nearly two thirds agree that knowing where they stand in comparison to clinical practices of colleagues is useful in their professional development
Q. 18 Knowing where you stand in comparison to the clinical practices of your colleagues is useful in your professional development Base: 122 (2012), 63 (2013)

20. Q19: Given that budgets are perpetually overspent, where should services be cut in order to fund investments for new or enhanced services?
Most respondents who felt able to give a response said cuts should be made in secondary care or that funding should be transferred to primary care.
Several respondents said that reducing bureaucracy would help.
Some suggested enhancing community services to reduce hospital attendances and stays.
Similarly it was suggested that spending in hospitals is out of control and that this increases the importance of primary care.
Many felt that they were not in a position to make these decisions and that the CCG Board should be doing this.
transfer more funding from secondary care to primary care
less management and monitoring
after due consideration from the board
Not enough information to decide
how about letting things stabilise before changing it all again?

21. Q20: How should service cuts in order to fund investments for new or enhanced services be agreed?
Respondents who answered the question gave a range of answers similar to those given in the last survey.
4 people said by vote.
8 said by the board.
3 people said this should be agreed at a national level.
5 people said decisions should be discussed at patch meetings and then raised at the board
6 others said in discussion or communication with the CCG and public.
A few respondents said they had no idea and many did not answer the question.
A few respondents felt it was unreasonable to cut funding further.
with public involvement but with courageous leadership

22. Nearly a quarter of respondents state that the CCG has their confidence that it will make decisions fairly and competently?
Q.21 Does the CCG have your confidence that it will make such decisions fairly and competently? Base: 122 (2012), 60 (2013)

23. Q22: What else could the CCG do to build your confidence that it will make these difficult funding decisions fairly and competently?
Vast majority of respondents are looking for transparency, good communications and explanations as to why decisions have been made.
Communication of these decisions needs to be timely and quicker than it is at the moment.
The CCG needs to demonstrate that any feedback and consultation with the GPs is considered/listened to.
A smaller number of respondents also said that focusing on local issues and having the opportunity to meet the board would also help.
Similarly it was suggested that the locality managers should visit and talk to the GPs on a regular basis
communicate with practices frequently
demonstrate that GPs are consulted and listened to
come and see the GPs in their practices, talk to them

24. Mentoring /buddying was specifically mentioned.
Q23: Acknowledging that all practices share a commissioning budget how do you think the CCG should deal with a practice which consistently and significantly overspends its fair share, thereby disadvantaging the patients of other practices?
Most respondents suggested a ‘softly softly’ approach in the first instance with practices being offered help, support and education.
Mentoring /buddying was specifically mentioned.
Naming and shaming was not felt to be helpful and the CCG should recognise differences between practices and try to understand these.
Only when this approach was found not to work did some GPs/PMs say that a tougher line, such as financial sanctions should be taken.
Some respondents opted for a firmer approach from the outset.
Other respondents stressed the need to be clear about measures being used and that the data must be robust and performance analysed on a case by case basis.
we need to recognise there will be differences between practices and attempts to eradicate differing referral patterns will harm patient care
link them up with a practice that is performing well and ask them to come in and advise where they can
the CCG should meet with the practice and provide assistance where required