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Practice league tables 'will baffle patients', NHS study finds

Publishing league tables to help patients choose a GP may be counterproductive and could even ‘arouse hostility' amongst the public, according to a new NHS-funded study.

Patients could be overwhelmed by comparative statistical information and be unable to 'understand its implications', researchers at the University of Birmingham's Health Services Management Centre found.

'Too much information can make people anxious, and information can affect different people in different ways. This means that any information needs to be carefully piloted with a variety of people,' the centre's report warned.

Pulse revealed last week that at least two trusts have already published balanced scorecards rating all local practices online, with 90% of practices in NHS East and North Hertfordshire receiving at least one red rating in 24 categories. NHS Choices will also allow patients to create league tables by ordering practices by score.

But after reviewing evidence on information about the quality of primary care services the researchers warned such information needed to be presented in the right way.

Their report says: ‘Providing people with comparative information, such as league tables, in the hope that it will encourage them to ‘shop around' may arouse hostility and greater support in defence of their current GP.'

Dr Jo Ellins, research fellow at the HSMC and co-author of the study, told Pulse that while some comparative information could be useful, patients often found narrative comments or feedback more useful.

‘Those elements are probably best presented in things like patient stories,' she said. ‘"Mr Smith says I use the practice and this is my experience of this doctor" is actually a very meaningful way of presenting information to people.'

Dr Ellins also warned NHS chiefs to be mindful of the ‘digital divide'.

‘At least 1 in 5 [patients] lacks basic literacy and about a third of the population doesn't access the internet,' she said. ‘There's a real danger that information is only being accessed and used and is only supporting informed choice among a certain part of the population.'

A spokesperson for NHS West Midlands said its PCTs were being invited to pilot a range of different ways of improving information for patients but the research would not necessarily affect plans for balanced scorecards, which were being led at a national level, she added.

Dr Grant Ingrams, secretary of GPC West Midlands, said that publishing league tables and balanced scorecards could lead to an excessive focus on targets – one of the reasons given for the recent ‘appalling' failures in care at Mid Staffordshire NHS Foundation Trust.

‘The SHA was very favourable about Mid Staffs, because Mid Staffs were ticking all the boxes,' he said. ‘If they bring in a similar thing for general practice, we're going to start seeing the same thing.'

Ranking practices may prove counterproductive and arouse patient hostility Key findings

- Comparative statistical information on practices such as league tables can be of limited value and may ‘arouse hostility'

- ‘Soft' narrative information may be of greater value, with patients more easily able to relate to anecdotes from service users

- Some patients, such as ethnic minority groups and low income families, may find it hard to access information online or even in patient leaflets, with 1 in 5 patients lacking basic literacy and 1 in 3 not accessing the internet

Source: Series of reviews on primary care information for the public, University of Birmingham's Health Services Management Centre.

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