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Gold, incentives and meh

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)

  • its the fact that I'll have to spend hours formulating some kind of "action plan" to correct my practice's antibiotics or benzo levels that I'm worried about.

    more paperwork on the horizon

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  • go ahead CQC do it - patients who expect everything will then know which practices to join - I don't think it will positively improve care.

    if you want to improve care then SUPPORT GPs who try to say no rather than hounding them.

    if a dr says no to antibiotics and then the following week that patient gets admitted - the hospital staff will say why didn't your gp prescribe antibiotics. patients will then complain to GMC, Daily Mail and get their solicitor ready because little johnny didn't get their antibiotics. after an investigation and stress to the gp the conclusion will be the gp at the time was right but the condition got worse and later on antibiotics were required. i know because i've seen it happen and the effect is to make practice defensive. But how different it would be if gps are innocent until proven guilty or if NHSE and CQC were supportive.

    ok - i will refuse to register bronchiectasis, asthmatic, copd, BDZ dependent and patients with phobias - happy now?

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  • Mark Smith

    Another straw. Another Camels back. So glad I've decided to emigrate aged 51. Won't miss this, or any other stupid unscientific pathetic Dr bashing idea from i**** Field, NHS England or any of the other wastes of money and space who think they 'run' the health service. Wouldn't recognize a real coal face if they ran into it. They just don't get it, and they just know they can get away with it

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  • what a bunch of idiots. Who will really care about this data. This data is not for public consumption, what does it tell anyone. The UK is a joke. Medical politics is a pantomime. The press is vindictive. One more reason to practice defensively and not in patients or society's best interests.

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  • Steve Field, supposedly one of our own!? The agenda becomes apparent when you drive such nonsense. Once, I held you in high regard, but no longer.
    Highlight practices so that they face closure, leaving a take over as the only option, probably by a private corporate provider, thus fulfilling the government agenda of spinning off primary care!

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  • Btw, benzo prescribing is often an issue inherited by new GPs coming into practices, and can be a futile exercise as it requires GPs to be consistent within a practice, and that is a challenge!

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  • Edoardo Cervoni

    I am left wondering about the intention of the initiative. Past experience tell us that low cost information campaign targeted at citizens, combined with a newsletter on local antibiotic resistance targeted at doctors and pharmacists, is associated with significantly decreased total rates of antibiotic prescribing but has no affect the population’s knowledge and attitudes about antibiotic resistance. Most often doctors are "pushed" to prescribe antibiotics and, alike for benzodiazepine, is the "fear of confrontation and complaints to deal later on with" the stronger driver of their prescribing. So, I would very much invest in high cost campaign and, perhaps , even consider the introduce a prescription ticket on some items, such as antibiotics and benzodiazepines. Overall, I believe that GPs should have more autonomy and decisional authority. Fear of receiving complaints has changed the way we practice medicine (defensive medicine) which is not good for the NHS and hence for the tax payers. "Because it has worked in the past", is a very scary concept as quite nicely put by Nassim Taleb in "The black swan".

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  • Thousands of years of healthcare, but in a few years, the CQC has turned caring hardworking professionals into 'criminals until proven otherwise'. How did we let this happen? How did we let our profession be destroyed in this manner?

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  • I accept the limitations of a simple survey such as that proposed, however, there is a massive problem with the past and current prescribing of benzodiazepines i.e. GP`s not following national guidelines which have been in place for many years ( 20+ ? ) Anything which sheds light on this could benefit patients who are suffering the effects of addiction to these dangerous drugs. Currently there is a complete lack of information ( as far as I am aware ) regarding prescribing practices and whether they are following guidelines.

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  • Simplistic in the extreme. Does Prof Field provide a convincing evidence base for the actions of the CQC? Is he able to show evidence of cost effectiveness and proportionality?

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