Posted by: Lisa Harrod Rothwell18 December 2014
‘Top marks, eh Doctor? The paper says you’re the best. You’re right to be celebrating.’
The CQC’s Intelligent Monitoring report has been published and the media has responded with the predictable frenzy of misreporting. Our local paper was no exception, running a headline along the lines of: ‘Revealed: The best and worst GPs’.
My practice scored a six and we have been ‘revealed as one of the best’. The positive endorsement has increased patient confidence and those visiting us seem to have greater appreciation for staff. Morale has been boosted.
However, this is an empty success.
I am not celebrating us being put in band 6. I’m angry. Angry that my dedicated colleagues elsewhere, who also work incredibly hard to deliver outcomes to patients that really matter, have been unjustifiably led into the line of media fire.
And angry that the bullets have predictably ricocheted into the public they serve.
Contrary to how the media has portrayed it, the report is the result of a desktop exercise to decide how the CQC should prioritise its inspections, using 38 indicators that include QOF data and patient satisfaction surveys.
The CQC states clearly: ‘This isn’t a judgment on GPs.’
And yet one of my local practices ‘revealed as one of the worst’ had a successful CQC inspection only two months ago. I would be delighted to be under the care of any of their doctors.
Many good practices have found themselves exposed to press bashing. Patients have unjustifiably been led to challenge their confidence in the services, which has adversely affected doctor patient relationships. Busy high-performing members of staff have been unfairly judged; morale has fallen.
Because of the report, clinicians have had to allay unnecessary patient concerns and respond to the media, which distracts them from their main work. They have also had to support staff while keeping their own heads above water. How can this be in the best interests of patients?
I fully support greater accountability and transparency for all NHS services and I fully support the identification of practices that may need some positive support to improve standards.
However, indicators used for the CQC report were never intended - nor fit - to be used to evaluate general practice. They are overly simplistic and fraught with confounding factors, such as population demographics, practice funding and premises.
As GPs we work with complexity. We see the nuanced nature of our patients - the interplay between their physical, mental, social, economic, spiritual and environmental wellbeing. We manage risk and uncertainty, and we care in a complicated system.
Clinically meaningful indicators could be very helpful to both GPs and their patients. But how do we quantify the key components of general practice - the strength and effectiveness of a doctor-patient relationship and its therapeutic benefits?
Exploring patient experience, though important to GPs, is a minefield. We already know that the people for whom we do the least are the most satisfied, and vice versa.
Accountability is a good thing, but inciting the public with the misinterpretation of a report is not.
Dr Lisa Harrod-Rothwell is a GP in Essex and former chair of a local CCG.