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Are online GP rating systems good for general practice?

Will online GP ratings help people make an informed choice about practices or be a dangerous platform for disgruntled patients? Two interested parties offer their opposing viewpoints

Will online GP ratings help people make an informed choice about practices or be a dangerous platform for disgruntled patients? Two interested parties offer their opposing viewpoints



Giving patients the opportunity for feedback will create transparency and trust, says Dr Shaibal Roy

The performance of GPs is the single most important influence on patients' experience of care. And if you agree with that, you'll start to understand the importance of measuring that performance. Online ratings of GP practices, focused on a patient's experience of their care, will enable GPs to understand their patients' needs in a new dimension. Your practice can only benefit.

Indeed, general practice as a whole will benefit from online ratings. Giving patients the opportunity to feed back their experiences will create transparency and trust – especially relevant in the current media climate. It will also promote choice and empower citizens. GPs who embrace online ratings will be showing they want to hear from patients on their terms.

Studies show that the opinion of fellow patients and carers is the second most trusted source of health information for the public (the most trusted source is GPs). The opinions expressed online will certainly then support the ability of patients to make an informed choice about practices.

Of course, there is an argument that patients already have the opportunity to feed back on their care, through complaints systems and the like. But you will probably know of patients who may have wanted to provide feedback on an aspect of their care, but have not done so because of the fear that doing so might adversely affect their future care. Online ratings give an independent voice to patients and carers, and the invitation to rate and review care without this fear is itself empowering.

But it is not only patients who will be empowered by the opportunity to rate GPs. Practices will be able to advertise their independently generated results to attract new patients. Individual doctor ratings would also be useful in GP recruitment, allowing a practice to pick out the best applicants through the eyes of patients. Positive ratings can protect and enhance a practice's reputation.

The most frequently mentioned concern with online ratings is the perceived risk of abuse and co-ordinated negative campaigns, and that's obviously a serious potential problem. But purpose-built, web-based systems prevent such negative campaigns, by identifying potential abuse and protecting personal information.

Disappointed opponents will then say there is no scientific basis for online ratings. This is an irrelevant argument because understanding the actual experience of care through the eyes of patients is not an academic exercise – it is a real-life evaluation of care.

The TripAdvisor argument – that GP practices should not be rated in the same way as you might a hotel – doesn't hold either. The public realise rating a GP is not the same as rating a hotel, and will adjust their behaviour accordingly.

GPs need to embrace online ratings. Continuous, comparative, real-time feedback on the actual experience of being your patient will empower practices to act on positive and negative feedback. Trends in ratings will highlight variations that may have been anecdotal before, but now will be supported by independent evidence.

Practices will be able to include a continuous, comparative, quantitative and qualitative, evidence-based account of their patients' experiences for appraisal and revalidation. And when there is an inevitable complaint, GPs will have an independently collected, continuous stream of information to minimise its impact.

To oppose the many benefits of online ratings for GPs, implemented safely and in line with the evidence base, is a reflection of culture, not logical reasoning. Online ratings will definitely benefit general practice.

Dr Shaibal Roy is managing director of ratings website IWantGreatCare and trained as a GP



Review websites are not the place for really important matters like choosing a GP, says Dr Paddy Glackin

Patient feedback on practices, published on the internet – couldn't possibly be a bad thing, could it?

I've used customer feedback websites myself. Before trips to China and Vietnam, I looked up the hotels I'd been allocated by tour companies. And very useful the reviews were too – in Ho Chi Minh City, I was primed to ask to see the room before checking in. Review sites are certainly useful for information about faraway places.

I've even posted a review after a trip to Paris where I was devoured by bedbugs. It wasn't the fact that I was breakfast, lunch and dinner to dozens of ravenous arthropods that led me to write the review; it was the Gallic shrug I received from the hoteliers when I complained. Venting anger is another useful function of review websites.

But really important matters like choosing a GP? I moved house last year after 15 years with the same practice. I wouldn't have dreamed of selecting a new one based on NHS Choices feedback. I asked a colleague who worked in the borough what the practice round the corner was like.

‘Excellent' was the response, and so it has proved. Patients use similar networks of information. Working in an inner-city practice with high turnover, I am often asked by patients moving to the suburbs if I can recommend any doctors in their new area. Picking up kids at the school gate, lunch at the pensioners' club, meeting friends, family and neighbours – these are all situations where people talk about their GPs and the quality of care they provide.

It's easy to find arguments against relying on online feedback in general practice. There is no evidence the patients commenting will be representative – the disgruntled are much more likely to post feedback than the happy.

And in healthcare, it is not the case that the customer is always right. The patient denied an antibiotic for a viral respiratory infection, or refused Viagra on the NHS, or the parent who demands separate measles, mumps and rubella vaccines – they all visit our surgeries and many leave feeling cross.

It's not as if there aren't opportunities for patients to express their views. Every practice is required to have a complaints procedure. Most have a patient participation group. PCT complaints managers will act as advocates on patients' behalf. Patients can complain to the GMC, their MP, the local press. Then there is the most direct route – patients can come in to the surgery, sit down and tell me to my face exactly what they think.

Patients can already access lots of online information about practices. NHS Choices has information about our opening hours, services and QOF scores. Patients are surveyed on access and the results published on the site. The PCT publishes its balanced scorecard on its website telling patients about our performance in prescribing, chronic disease management and vaccination. Go to gpcontract.co.uk and you'll see a detailed breakdown of our QOF scores, and London Health Observatory has a wealth of public health and clinical performance data about practices.

If the Department of Health really wanted patients to be informed, it would have included all this information on NHS Choices. Instead we have the cheap gimmick of ‘what patients say' and ‘add your views'. The contrast with education, where you can read your local school's full Ofsted report online, is telling.

Online feedback is yet another facet of this Government's attempt to transform patients into mere customers, degrading their relationship with doctors into a business arrangement. Instead of affirming patients as co-owners of the NHS, they become consumers with no real power other than to complain or switch provider.

And there's the nub – this Government believes only when patients start behaving like proper consumers and switch their doctor every three or four years will the power of the market to deliver improvements be unleashed. It'd be laughable if it wasn't so dangerous.

Just in case anyone suspects I have an axe to grind, I checked the feedback section for my practice profile on NHS Choices today. There is one entry. It reads: ‘Lovely practice – always has your best interests at heart. The doctors are very good and the reception team superb.' Thanks Mum.

Dr Paddy Glackin is a GP in Camden, north London, and a medical director of Londonwide LMCs

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