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King's Fund inquiry attacks 'micromanagement' of general practice

By Lilian Anekwe

Ministers have been advised by the most wide-ranging ever inquiry into general practice to ditch controversial ‘micro-measures' of GPs and transform the way they incentivise the profession to improve performance.

A discussion paper from the King's Fund's inquiry has criticised the heavy focus on numerical measures of GP performance, and urged future GP consortia to move away from ‘mandated micro-measures of care processes'.

It warned ranking GPs in league tables and rating them using balanced scorecards had led to a focus only on the poorest performers and failed to engage better practices.

The broad thrust of the inquiry's findings was revealed by Pulse in the run-up to the general election in May. As we reported then, the authors are urging politicians to consider ‘new metrics' to incentivise GP improvement that reflect areas such as patient safety and continuity of care, ‘which have been neglected in recent years'.

The report, written by GPs fellows of the NHS Institute for Innovation and Improvement as part of the King's Fund's inquiry programme, criticised the previous government's heavy reliance on league tables and balanced scorecards, which ‘have limited potential for benchmarking to encourage average or good practices with performance'.

‘Comparing practices with their peers will often produce data that is normally distributed around a mean. This may motivate those performing below average to improve, but is unlikely to have the same impact on higher-performing practices.'

Instead, GP commissioners should reward practices for quality improvements over time, and offer financial incentives for different levels of performance, according to the authors.

‘One way of achieving this would be to use more sophisticated analyses comparing practices with the top decile of peers and rewarding differential performance. Another would be to incentivise progressive improvements over time.'

The authors heavily criticised current measures of quality for failing to control for confounders such as practice deprivation, age and disease prevalence, meaning ‘it is not possible to draw meaningful inferences about differences between practices'.

Dr Robert Varnam, a GP in Manchester who co-wrote the report, said he was very hopeful it would shape future policy when it was submitted to ministers.

‘For a long time things like continuity of care have all but been ignored. But the white paper does speak about focusing on things that are harder to measure. The Government is going to have to be much less prescriptive, and if it is things could improve dramatically in the next few years.'

Dr Robert Varnum

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