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GPs go forth

CQC to publish practices’ antibiotic and benzodiazepine prescribing data

The CQC is set to publish individual practices’ data on GP prescribing of antibiotics and benzodiazepines, in a move GP leaders describe as ‘dangerous and simplistic’.

Professor Steve Field, the chief inspector of primary care, told GPs at the RCGP annual conference that the CQC would be putting detailed data on prescribing and other measures in the public domain ‘very soon’.

This will be part of a range of practice performance measures – which also includes retired QOF indicators – that the CQC is going to publish for the purposes of ‘intelligence monitoring’ to inform ongoing inspections.

However, the move has been attacked by GP leaders for failing to take into account demographics, and that scrutiny of the prescribing of antibiotics is ‘trendy’.

The CQC will on Thursday publish a handbook for GPs, which is set to provide more detail about how practices will be given ratings of ‘outstanding’, ‘good’, ‘needs improvement’ and ‘inadequate’, similar to the way schools are rated by the Ofsted regulator.

Responding to a GP’s question at the RCGP conference, asking about what criteria practice ratings would be based on, Professor Field said that ‘a lot of GPs - including the [RCGP], BMA and other organisations - have been involved in looking at the ratings’.

He added: ‘But we’re also going to publish lots and lots of data on every practice very, very soon, which takes it down into the prescribing of antibiotics, prescribing of benzodiazepines, a lot of it on the patient survey. All of that data will be in the public domain very, very soon.’

The CQC said it is formulating plans to use this data for ‘intelligence monitoring’, to understand which practices should be prioritised for inspection.

But GP leaders expressed concern at the proposals.

Dr Bob Morley, GPC lead on contracts and regulations, said he was not aware of how the data would be published but that he would be concerned that putting it in the public domain without contextual information would be misleading.

Dr Morley said: ‘I’m very concerned that this data is to be publicised and propagated as being a marker of good practice. That is a dangerous and simplistic assumption.

‘Individual prescribing rates and the reasons for them are an extremely complex area with all  sorts of issues affecting rates including local demographics, morbidity, availability of other services locally, secondary-care initiated prescribing and many other factors. They should not be considered in the absence of knowledge of the exact context and circumstances in which the practice is working.’

Dr Peter Swinyard, chair of the Family Doctors Association, said the data would not be helpful to patients and would add to GPs’ ‘grief’.

Dr Swinyard said: ‘The problem is this raw data doesn’t tell you anything. I don’t think it’s helpful for patients to publish this incredibly detailed analysis – even with the best of intentions it will be used to made into rankings and ratings, and there is probably no genuine difference between the fifth ranked and the 95th ranked practice.

He added: ‘It’s just another way of causing grief for us, and goodness knows we have enough already.’

Asked to comment on why Professor Field had singled out prescribing of antibiotics and benzodiazepines specifically, Dr Swinyard said: ‘Because it’s trendy – because they can, because they can measure that. What they can’t measure is the number of hours GPs spend talking to patients and trying to help them use their drugs responsibility and get the best benefit out of them. There isn’t a league table for that.

‘And the danger with all this is that we end so busy rooting around in the data we lose sight of the patient – you can’t reduce patients to a number.’

The Government recently launched a test platform for ranking GP practices on on the NHS Choices website, despite the GPC objecting to the publication of practice level data on such measures, including cancer referrals, on NHS Choices.

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  • Steve Field

Readers' comments (21)

  • the CQC do need to justify their existence

    There are some politicians who are openly talking about reducing the role of CQC already and tthe CQC will need to show it is collecting doing 'metrics' because that Is what counts!

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  • The deprived areas generally have more ABx and Benzodiazepine prescription and hence it will hit deprived areas disproportionately. As usual with CQC`s agenda this is targeting a certain group of doctors who work in deprived areas.
    Now we know CQC`s real agenda.

    This data is already available publicly on HSCIC websiteand previously in NHS comparators and CCG`s are aware of same already. The proportion of patients with mental health problems vary between practices by several fold and this has a effect on Benzodiazepine prescription rates.

    Patients cannot interpret this data meaningfully without seeing the proportion of patients who have depression/anxiety and other mental health problems and hence of little use for public rating. This can be given to CCG`s or LMC`s and they can interpret same based on various factors such a university, deprived areas, immigration, transient populations (holiday resorts) etc.
    Taken in isolation this is meaningless and if CQC doesn`t know that its pathetic as Americans say- You do the math!

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  • to be honest as long as enough data is published - it will be all noise

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  • Why? Surely the obvious downside to this outweighs any theoretical (though none immediately springs to mind) benefit.

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  • Just ran this past my son who said
    ...what a waste of money and
    ...if I wanted antibiotics and benzos I would know which practice to join.

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  • publish whatever he likes. I'm getting the f*** out of here.

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  • This comment has been moderated.

  • Nhsfatcat

    Another fantastic move. Why not use the resourses that Professor Field and the CQC are using to look at the outliers and bloody well HELP THEM.

    I rarely swear at non-sentient objects but the CQC got a huge mouthful via my computer screen.
    Queue the obvious.......

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  • Pure empire building, job-self-justifying, and ego enhancing behaviour by an out of control, not held to account, bureaucracy.
    CQC will continue to get much more worse and worse......

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  • Above all do no harm...but feel free to ignore this if you work at the CQC.

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  • You cannot refuse to register a patient on the grounds they are a benzodiazepine addict
    If you supply them Professor Field will report you to the responsible officer
    If you do not the patient will complain and you will be obliged to report this in your appraisal to the representative of the responsible officer
    The responsible officers themselves remain mute,what precisely are their criteria and standards here
    Perhaps the way forward would be secondary care benzodiazepine clinics
    An expert consensus gp committeee of 26 GP,s with one consultant representative and an expert patient should be convened to produce guidelines for secondary care on establishing these clinics

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