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At the heart of general practice since 1960

Patients' backing for a choice of hospitals

andy jones

Premier league

In January I suggested the Freedom of Information Act would be one of the Blair premiership's greatest legacies. With the publication of GP league tables, we have just seen the best and worst parts rolled into one. GP performance data was never supposed to see the light of day, but several commercial organisations were seeking to collate figures under the Act, forcing the issue for ministers.

Undoubtedly this is good news. GPs have demonstrated a staggering average score of 91 per cent across the domains. This is the Act at its best, getting information about public services into the public arena. Patients can see just how local surgeries have fared. Unfortunately, the data was not designed for public consumption and has been presented in some of the most unappetising spreadsheets ever seen.

Patients will be lucky to identify which is their own surgery, let alone the total outcome score. A far more meaningful exercise would have been achieved by attention to presentation.

What choice?

Patient choice is still a favourite political football, but the release of this data is a drop in the ocean. In many metropolitan areas it is difficult for patients to register with any local GP, let alone one of their choice. Practices are broadly similar because of centrally dictated contracts.

By and large practices have the same opening hours. The less said about appointments the better.

It is clear that few outside general practice have any understanding of the complexity of patient demand. Broadly, the laws of supply and demand prevail. We all have far more patients than in any other developed country. The increase in whole-time equivalent GPs has been so ludicrously small that for most areas GP services remain under strain.

Some health commentators (Roy Lilley) report that we are just being paid for work that was already being done. I disagree. Many surgeries had chronic disease clinics in the past, but it is the advent of systematic care that is benefiting the absent minority.

We all know that real pathology is found by dragging recalcitrant attenders kicking and screaming to the surgery from the depths of a recall list. It is with these patients that the real value of systematic care lies. We are building some of the most valuable and admired public health data in the world, GPs should be proud to lead the way.

Shortsighted

It is somewhat irritating that the cash crises of PCTs and acute trusts are blamed on the high levels of achievement by GP surgeries. Like it or not, the NHS had a budget deficit of around half a billion pounds last year. GPs' total achievements have exceeded net predictions by a mere £200 million. This money should be seen as a health credit and a future saving, not a burden.

Until we stop moaning about heath costs in this country and start concentrating on public health, the NHS will remain a political football. For this month GPs are top of the league as my 'managers of the month'.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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