Give ’em the DES cash – We name the Wandsworth practices who’ve earned it

Locally there is £407,000 worth of extra dosh available to the 46 Wandsworth GP practices this year and the same again next. All they have to do is demonstrate that they have got  some basic building blocks of patient engagement in place and they can collect £1.10 per patient.  Serious money in a time of resource restraint. Astonishing then that only 19 out of the 44 practices we surveyed have bothered to do the necessary for themselves and their patients.  Perhaps the Daily Mail is right about what GPs are earning and this was too little reward to bother with?  Why did the majority of practice not Pass GO and collect their share of the money for the Patient Participation Directed Enhanced Service (PP DES) for Year 1?  Money aside, this is worrying for patient engagement in the practices of the emerging CCG – which is supposed to be a “Pathfinder” after all.

What we looked for in our survey last week

We checked the practices twice last week for the four things GP practices should have done or set up to comply with the PP DES:

1) existence of a patient reference/participation group, which could be a virtual group;

2) existence of a functioning and accessible practice website;

3) posting of patient survey report on the practice website; and

4) ability to access patient survey report through the website.

All the principal four tasks we looked at  should have all been completed by 31st March, according to the DES guidance published by NHS Employers and the BMA’s General Practitioners Committee a year ago.

Short of the mark

In this day and age in the NHS, one surely would reasonably expect every GP practice to have at least a basic, up to date and accessible website.  So why don’t all Wandsworth practices meet this basic standard? Twelve didn’t.

For 18 practices there was no evidence of a patient participation group.  Of course there may be some PPGs in practices which lack a website, but this is something that would require more investigation than was possible in this survey.  At any rate, just having a patient reference group is not sufficient for PP DES compliance.

Only 19 out of 44 practices surveyed had actually posted a completed patient survey on their website.  Surely this should have at least been 26 practices who also had a patient group which was mentioned on their website?  Several sites had evidence that they had completed a survey and even discussed it with patients (all as required by the DES) but then had failed to post it on the website.  This means non-compliance.  Why did this happen in seven practices?

That leaves just 19 of 44 practices which, in our view, are compliant with the Year 1 requirements of this DES and are entitled to their payment.  This is a disappointingly low figure.  Some of the reports we dipped into were excellent and clearly a lot of work had gone into them.

It wasn’t just the mega-practices who performed well – in fact, some of them didn’t comply, certainly when compared to several small and medium sized organisations who met all the requirements and did so clearly and efficiently.  We recommend  that the information in the patient surveys should be collated and disseminated  as “top line messages” by the PPI Team at Wandsworth PCT working with LINk/Local HealthWatch to the Wandsworth CCG and the Health and Wellbeing Board as well as the general public in the borough.

Step forward the deserving 19 and take a bow

Since we believe in rewarding success, we thought it worth listing the compliant practices in Wandsworth.

  • Balham Park Surgery
  • Battersea Rise Group Practice
  • Bedford Hill Family Practice
  • Chartfield
  • Chatfield
  • Danebury Avenue
  • Greyswood Practice
  • Heathbridge Practice
  • Lavender Hill Group Practice
  • Mayfield Practice Roehampton
  • Mittal “Open Door” Practice, Boundaries Road
  • Putneymead Group Practice
  • Roehampton Surgery
  • Southfields Group Practice
  • Streatham Park Surgery
  • The Triangle Surgery
  • Thurleigh Road Practice
  • Waterfall House
  • Tudor Lodge Health Centre

Detailed Findings for the 43 Practices  

Practice-specific website accessible 33/44 One practice’s URL did not exist according to BT so unable to access website and assess compliance
Evidence of a patient reference/participation group 26/44  2 were said to be “virtual groups” which is allowable under the PP DES
Patient survey report completed and posted on website 19/44 Several practices reported their patient group had discussed the survey, but it was not posted on the website as the PP DES requires
Compliant with the Year 1 PP DES 19/44 This reflects the four factors used in this survey
Not compliant  with the Year 1 PP DES 25/44 One practice could not assessed for above reason

You can read the full report here.

What happens to the money? 

So what will happen to the £814,000 which local practices could earn from the Patient Participation DES over its two years of life?

Certainly for Year 1 payments, we look to Wandsworth LINk working closely with the Wandsworth Borough Team (what’s left of the PCT) to make sure that practices are not just “tick boxed” through this DES and handed public money they have not earned.  Requirements must not be ignored and deadlines must be honoured.  It must all be transparent and open to scrutiny.

We have always advocated more data being made available to users and this is an opportunity to demonstrate that the data can be used to reward achievement and more than that, avoid a fudged outcome where guess what? everyone passes GO and collects their dosh even if they have done nothing on their way round the board.  By putting our survey results in the public domain, we hope we have helped to prevent any chance of that happening.

Now that this report is in the public domain, we hope lots of people will send it on and start asking questions, and not just locally, about what is happening to the £1.10 per patient multiplied by all the registered patients in England – not a small sum.

The Moore Adamson Craig Partnership supports user and public participation,  trains lay representatives and develops responsive  health, care and education organisations.  We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing.  Feel free to contact us to discuss the opportunities.




  1. says

    A frequent reader suggested we send this blog to the Minister (English variety) who has responsibility for patient and public engagement/involvement. Good idea. But I don’t know who in Mr Lansley’s team this is (that should have rung a warning bell). I went to the obvious place to find out, the Department of Health website. Guess what? Looking at the list of ministerial responsibilities on the DH site, PPI/E isn’t even mentioned for any health minister. I tried googling. Still no luck. There is tons of redundant guff about PPI/E on the net, but no where could I pin down current ministerial responsibility for it. I asked around some policy wonks and the general view is that ministers have handed PPI/E responsibility to civil servants. Well, that speaks volumes doesn’t it? “Nothing about me without me” rings even hollower if the accountability line does not go up to the very same Ministers who used it in the first place.

  2. Simon Young says

    Paul Streets and Joan Sadler seem to be the PPE leads at DH (or were til recently).

  3. Andrew Craig says

    I think that’s still the case and they are capable and well intentioned people. But it could all change, and not in the right direction either, with the appointment of the recently-advertised (at £165,000 pa) post of National Director of Patient Insight at the NHS Commissioning Board. You really could not make up such a title, so it must be real. The job spec stresses informatics strategy which is worrying.

    Insight is not just data. The output from useful tools such as Net Promoter Scores is not the whole of patient experience by any means. And it CERTAINLY is not a substitute for patient and public engagement. Serious engagement is the basis of insight, but it seems to be moving further and further away from the concerns of the “new” NHS – or as Roy Lilley so aptly terms it, the “Nicholson Health Service”.

    Readers may have noticed that Ruth Marsden, Vice Chair of NALM, has put her hat in the ring for the NHSCB job and published a manifesto, including this great line: “We are people, not ‘units of data’ to be ‘managed’. It’s time to junk the rhetoric, stop talking about ‘culture change’ and start doing it”. Good luck Ruth!

  4. says

    The Tooting South practice website has changed in the past couple of days. They have added a “patient group” button on the front page which leads to the patient survey. This was not present when all the sites were examined twice on 2nd and 5th April. The DES rules say compliance depends on what was posted by 31st March so they remain in our view non-compliant. We will keep our report unaltered, so it stands as published as a matter of record. LINk can then use it as a reference point if it wishes to agree a final out-turn with the PCT about compliance.

  5. Chris Rowland says

    Hi Andrew

    As the Locality Management Lead for Battersea, I would really like to discuss the content of your survey. You have done some great work in pulling together this information however, there are some inaccuracies in your findings that I feel we need to sort out as soon as possible, especially as the information in your report is now public and I see that you have been encouraged to send this to Mr Lansley’s team. For example, the list of practices you have is not up-to-date and one practice has voiced their concerns to me, as they had the information on their home screen before the 31st March and this was missed in your report.
    Please get in touch as soon as possible.
    Best wishes

  6. says

    In response to the above blog:

    1. Sai Medical Centre does indeed have a website
    2. The patient survey is easily accessible on the ‘Patients’ page

    We prioritise our finances towards patient care. As we are a small practice we do not have the budget to pay for Google Ads and so our website is unfortunately located on the 4th page of the Google search.

  7. Caroline Millar says

    Thanks for your feedback Shobana and Chris.

    Andrew is away at the moment but I am sure he will respond in detail as soon as he gets back. As the blog says, we were looking for “accessible” websites and so we used a popular search engine to look for them. Those which could not be easily found by someone who did not know the web address were assessed as not being accessible. Andrew could not find the Sia Medical Centre when he searched and I searched again on 23 April and could not find it at all. However The Sai Medical Centre kindly sent us their website address on Monday in response to the blog and we have since checked out their site and can confirm that there is now a link to the patient survey on it.

  8. Andrew Craig says

    I’ve been away for a month and a bit, but have now gone through everyone’s comments. Good to see the level of interest, that was one of the objectives. Remember, this was a snapshot on a given date working from website information accessible in the public domain, not a research study. Any member of the public should be able to find this information easily. We reported on what we could find.

    The PPDES is voluntary of course, as some GPs pointed out, but we would expect all local practices to take it seriously if they want to succeed as part of new CCG.

    Some websites have definitely done more about survey results and information about participation since we looked at the beginning of April. That’s excellent news. But it doesn’t change the snapshot results.

    The final decision about compliance and payment will be taken by the PCT, of course. Our report is a reference point only. The final outcome will be interesting. As will achievements in Year 2 of the PPDES.

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