Six million people can be wrong

There are a lot of statistics bouncing around about extended hours. One that keeps coming up is the demand of six million patients for them. Here we have no less a figure than the Secretary of State for Health answering a question in parliament.

About 6 million people in our patients survey said that they want improved access to their GP in the evenings and on Saturdays, which is why we are seeking to reach a negotiated settlement with the BMA.

The survey he seems to be talking about here is the 2007 GP patient survey. Looking at the results things are not quite as clear as they might seem from the above answer. For a start six million people did not say anything of the sort. There were not even six million in the survey. The survey was only sent to 4.7 million people and less than half of them (2.3 million) sent it back. The people sent surveys were picked largely from those that had been to their GP in the previous six months.

So where does this figure of six million come from? Well out of those who replied 16% said that they were, in some way, dissatisfied with opening hours. Take that figure together with the population of England over 18 (just shy of 40 million) - multiply and you get a figure of around around about six million. Clearly what Mr Johnson intended to say was that if the whole adult population had been asked and they all replied he believed that six million people would say that.

Now that is a pretty rotten bit of statistical conjecture. It assumes that all of those people who did not reply would think the same way as those who did. Of course it may be they did not reply because they had not particular views. Even more ambitiously it assumes that that group that were not polled - people who had not seen their GP recently - had identical views.

Worse still it ignores the fact that only ten per cent were able to say in what way they were unhappy with the opening hours (lunchtimes, evenings etc). Only 208,000 asked for increases outside of the usual 8-6.30 Monday to Friday - about 9% of the total responses. It is difficult to call this a massive pressure. Even with the simplistic extrapolation this would only be 3.6 million. The pie chart graphically shows the responses (click on it to enlarge).

Its not just me saying this. When you pay 11 million pounds for a survey MORI gives you some quite detailed analysis - in this case 111 pages (2.4Mb) of it. So what do the experts have to say?

When interpreting the findings, it is important to remember that the results are based on a sample of patients registered with a GP in England who responded to the survey, and not the entire population of England.

The vast majority of patients (84%) say they are satisfied with the hours their GP practice was open during the last six months, while the remaining 16% say they are dissatisfied with the opening hours.

What do we know for sure then? Simply there is some demand for extended hours, but not a lot. You can read the MORI report for some detailed socioeconomic breakdown of the figures. What is quite clear though is the figure of six million people is definitely wrong.

Changes to Extended Hours DES

In the fast(ish) moving world of GP contract negotiations the finances of the extended hours DES have changed again. In his latest letter to the profession Lawrence Buckman has announce an increase in the rate of payment from £2.80 to £2.95 per patient for extended hours. It has also been clarified that the survey will be in QOF and not part of the extended hours DES

This is in general good news - there is more cash for providing extended hours under the DES although and this is surprisingly substantial for many practices. I have updated the extended hours calculator which can be accessed from left hand menu the practice pages.

I have also corrected a bug which overestimated the hours required for about one in six practices. Sorry about that and thanks to the eagle eyed reader who spotted it.

The contents of the DES are still far from fixed as you can see here and here.

Questions in the House

Perhaps an old fashioned phrase to describe a significant event but there have been questions in Parliament about the QOF. At health questions this week the Alan Johnson defended of putting cash into extended hours rather than clinical areas. He accused the BMA of propaganda in suggesting the reverse. That suggestion seems to have produced a sharp intake of breath from the Honorouable Members. Ultimately though, like most parliamentary answers, there is more heat than light here.

Overextended?

The changes to the QOF detailed on this blog and the detailed calculations of losses under the proposed contract imposition are only a relatively small part of the current issues between GPs and the government. The central issue from Numbers 10's point of view appears to be extended hours. If the governments proposals are accepted then a Directed Enhanced Service will be commissioned for these extended hours. The politics are complex an I would direct the interested reader to Lawrence Buckman's letter to the profession.

The fundamental drive of the DES is that there should be 30 minutes of extra time per one thousand patients on the list to be delivered in 90 blocks in the evening or weekends or 60 minutes in the mornings. We are, however on shifting sands here. A new provision brought in at the end of January is that there should be no time when reception is closed during the core hours. Any reception close would have to be replaced with clinical time. The extended hours would be agreed with the PCT and based on the results of the GP Patient Survey, a national survey of patients about primary care.

The results of the patient survey have been published and so the figures can be used to work out an estimate of the impact of the DES. What I have done on this site is to calculate the amount of time required from each practice and then allocate those hours according to the result of the survey. Thus is 51% wanted weekend access and 49% evenings and there were two sessions to allocate then there would be one to each. If there was only one it would go to the weekend. A fairly simple formula but it does make it easy to automate. The ultimate detail is in the source code.

The results can be seen on the practice pages. The summary is that it is not the couple of hours a week that many imagined. 55% of practices will be required to produce three hours or over on a Saturday. Around 160 practices would also be doing Sundays under this formula. Interestingly only eight practices would be required to provide early morning surgeries.

Some of the problems with the current proposals are also seen. It is widely reported that simultaneous surgeries would not be permitted (i.e. you could not supply three hours of time by two GPs working for 90 minutes simultaneously). One of the effects of this rule is that opening hours for smaller practices will be considerably less than those for larger practices. Under this rule two practices would be open from 8am on Saturday until half past midnight on Sunday morning. Clearly this is absurd.

I will try to keep the model updated with changes, but there remains a lack of detail in these proposals, and much of the detail that does exist may not be that practical. Obviously if anyone from the government side of negotiations knows better then the email address is below!