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NICE should develop new quality metrics for GP practices, recommends review

GP practices are facing the publication of a new set of performance indicators on the quality of their care, under proposals published today by a Government-commissioned review.

The report, led by Dr Jennifer Dixon of the Health Foundation, recommends that patients and NHS managers should be able to easily view how a practice is performing in comparison with others, including those with a similar profile.

The indicators would include data already in the public domain, such as CQC ratings, NHS Choices and Public Health England practice profiles, which would be consolidated on a single website.

But the report also recommends NICE develops new metrics to measure GP practices, similar to the work it does developing indicators for the QOF.

The authors do not recommend what the final indicators should be, but they recommended ‘development, potentially by NICE with others’ of a small set of indicators that show information about ’what matters most to the public, healthcare professionals and those accountable for the quality of general practice’.

The report was first announced by health secretary Jeremy Hunt in his ‘new deal’, in which it was mentioned that the Health Foundation would be doing the background work for the development of a ‘scorecard’ for practices.

But the report wholly rejects giving practices an overall rating, and it says that such measurements will not form a ‘scorecard’, adding that the term is ‘divisive’.

Pulse revealed earlier this year that RCGP had said it would not engage with the consultation unless plans for a ‘scorecard’ were dropped.

Dr Dixon told Pulse: ‘The first thing would be to consolidate the data and that NICE helps to develop the set of indicators that we have got already. At the moment, it is unclear how the indicators are developed and they need to be linked to some kind of quality improvement strategy as well.

’We think that NICE could convene a number of stakeholders to do that well, a bit like they do already for the QOF, but to expand that.’

Dr Dixon said that the metrics should be ‘value-free’, showing performance compared with the average practice and those with similar profiles.

The Government has been pushing for its new ‘MyNHS’ website to include data on all healthcare providers, and it included the CQC’s ‘intelligent monitoring’ rating for GP practices, which was later withdrawn after problems were found with the data.

The Health Foundation says that ‘the direction of government policy is towards establishing MyNHS as the primary portal for information about the quality of health and care services’.

It says that, if MyNHS were to be used for this purpose, the Government would need to conduct further market research ‘given the limitations of the MyNHS website’.

The report said: ’The term ”scorecard” is divisive - we recommend avoiding this terminology if a key purpose is for improvement. There appears to be low awareness, among GPs in particular, of the main websites currently containing quality indicators for general practices.’

Readers' comments (14)

  • Why am I not filled with joy? All these highly effective organisations with well meaning and intelligence divising scorecards etc... Why not spend this money on health care?
    I'm sure if I developed a scorecard for my family on their delivery of homework, tiding up, on my cooking and punctuality we'd be a much more efficient value for money family!

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  • The reason why the word 'scorecard' is so divisive is that it represents a response to some of the most appalling statistical practices that have been inflicted upon hard-working practices in the past.
    I am fully in favour of scorecards (as I suspect we all are) but ONLY if what is being measured is based on accurate data, fairly and properly analysed and fairly and properly presented.
    However, historically, the NHS has played fast and loose with statistics - not comparing like with like; creating scorecards using incorrect or unverified data; creating rankings where like isn't being compared with like; using data for different purposes than for which they were collected (eg using QOF points - really just for payment - to create practice rankings); and making spurious assumptions about whether a set of data (say, crude referral rates) is a true proxy for 'the good doctor' (it isn't). Perhaps the worst of all is where practices are scored using criteria that they aren't fully in charge of - especially where patients are expressing a choice - such as 'the percentage of new mothers who breast-feed', or those who choose not to have their children vaccinated.
    We desperately need high-quality, reliable, objective measurements of practice and personal abilities within the NHS. The problem is that they are extremely hard to come by. Any botched attempt to create them therefore merely adds to the level of suspicion in the minds of practices and clinicians.

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  • The GPs need to be accountable to their paymasters,the tax payer and having metrics is an essential part of that system

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  • Another set of metrics
    Less patient contact time
    More form filling - More pratcice managers saying "enough"
    More metrics for new GP Commissioners to monitor
    More elements to introduce for transformation in primary care
    Clash risk with current evolving standards and merics
    Not a socrecard?? of course it will be perceived as a scorecard

    More stcks
    More exposure
    More complexity
    More disruption
    More ill health in the workforce
    More resignations from Primary care
    Less young doctors taking up General Practice
    ....... keep beating the foundation stone of the NHS

    Resource Primary care effectively.... and
    ONLY THEN introduce this... Quality with pennies is a pennies worth of quality.

    Less than 10% of investment from NHS budget
    Shame on you

    The system is destroying secondary care too - 500billion deficit in foundation trusts in first quarter. ... 930 billion deficit in all trusts.
    What will be left?

    Someone has to say stop... seriously. You are destroying our beloved service.
    Someone somewhere is saying... let us take the NHS to failing point; push it to the limit.... over the edge
    Then they can do the knight on white horse act and start to procure transatlantic providers. They are ready. Go ask them yourself. Offices in Canada I believe...

    There are industries that have crippled the nations and global economies. If they built a few less glass syscrapers and less marble lined corridors they could make the difference... will they?

    Before you accept this situation... ask your older patients who remember the NHS before 1948. They will tell you the story and what they would choose.

    Leaving NHS general practice very soon with tears in my eyes.

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  • This just sounds like more moving of the goalposts in a game in which performance can't be measured by counting goals.

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  • I repeat
    Asking for quality with pennies is getting a pennies worth of quality

    This is of course tax payers money and we should be accountable for it

    However where is the scorecard for those who allocate centrally the funding of primary care and devise new contracts for our juniors and consultants alike. Are they value for money and spending the taxpayers hard earned tax wisely.

    I say absolutely not..... How many voices does it take for your boss to sit up and listen.

    We are but water on a wall and the only way to effect change is target the front door together....

    Yes we should be measured but the complexity expected to be delivered at a primary care level is not met by commensurate funding.... And before someone says GPs are wealthy enough I am talking about funding that is entirely ploughed back into patient care not GP salaries... And please look to the figures on GP incime which has fallen year on year for 4 years.

    So I repeat
    The quality paid for in pennies gets but a pennies worth of quality

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  • oh go away- just leave us in peace- our quality metrics would improve hugely if we could be properly staffed and funded- keeping on measuring things and blaming us when everthing is falling apart is absurd. If you want one exapmple - here it is. We used to see our district nurseS (NOTE THE PLURAL) every morning and could keep very close tabs on all our seriously ill patients at home - now we see them once a month if they turn up to our palliative care team meeting (without any palliatve care nurses ever). If we had properly staffed and communicating district nurses all this keep them out of hospital for a few more years (where they will end up eventually) would be much more effective.

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  • Dear well meaning people,

    To quote Bob Dylan... many times must a man look up
    Before he can see the sky?(Difficult for those whose head is so up their own ....)

    Yes, and how many ears must one man have
    Before he can hear people cry?
    (Yeah , us GP`s crying due to workload and stress)
    Yes, and how many deaths will it take 'til he knows
    That too many people have died?
    (patients without access to healthcare as you close all the local surgeries which are good but may not be brilliant)

    The answer, my friend, is blowin' in the wind
    The answer is blowin' in the wind.

    The question is how much for how much?

    What can be expected from primary care with the present funding?

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  • "Dr Dixon said that the metrics should be ‘value-free’, showing how they are around performing compared with the average practice and those with similar profiles." Yes compare with an average practice in a country with a similar GDP as ours please. Lets make some international comparisons and work within that context.

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  • Nick and Anonymous Bob Dylan quoting GP

    THANK YOU:))

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