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The triumph of data over reason

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I’m not sure whether to send congratulations or commiserations to Professor Steve Field on his new appointment as Chief Inspector of General Practice. With such a high-profile post I’m sure he is chuffed to bits, but surely he has taken on a poisoned chalice, and it is only a matter of time before he becomes the most hated GP within the profession? He seems a nice bloke, I wouldn’t wish this on him - I wouldn’t wish it on anyone - but he must know what is coming.

Prof Field says his new role is about ‘much more than inspecting practices’ but having Chief Inspector in his job title is going to make this a hard pitch to sell. He is to oversee a new ratings system for General Practice, which Jeremy Hunt insists won’t be ‘just measuring the dials’, but Dr Mike Bewick, NHS England’s Deputy Medical Director says that comparative data on ‘access, immunisation rates and hospital admissions referrals data’ would be published - if these aren’t dials then I don’t know what are. Dr Bewick says this is ‘the most exciting thing to happen to primary care for some time’. I think he needs to get out more.

Somehow I can’t quite imagine that new arrivals to a catchment area are going to want to check out the local immunisation or referral rates before choosing a practice - a recommendation at the school gate is always going to trump such meaningless data. When it comes to referral rates in particular, I’m not sure patients will want the same thing as the Government - politicians are always trying to drive them down, but patients might prefer a GP who will provide easy access to secondary care when they need it.

There will be ‘patient experience’ for these ratings as well - like the woefully distorted Friends and Family test (which, rather worryingly is ‘but a small part of what we are asking for’). The justification for this, according to Dr Bewick, is: ‘Wouldn’t you want to know what your patients think of you? Wouldn’t that be a good idea?’ Well, yes, of course I would - but am I naive to suggest that I have a pretty good idea already?

We have had national patient surveys for years, NHS Choices feedback and a Patient Participation Group for the last 18 months. Patient Satisfaction Questionnaires are now embedded into revalidation, and for those who are not satisfied we take any complaints very seriously. More than all of this, however, is the importance of spending time with patients.

I try to listen to my patients - I’m not unusual in this, it’s what we GPs do - and they tell me what they like, and what they don’t. I know that what really matters to them is that they can share their problems, feel listened to and are given time. I don’t like running late, or the fact that one of my patients sometimes finds it so hard to see me that he’s named me The Scarlet Pimpernel, but if I listen, give time, and genuinely care, it’s surprising how forgiving patients can be.

If the new rating system could beat talking to patients as a method for understanding the needs of my patients then I would be happy to join the queue - but it won’t. Like all ratings systems it will drill down to reducing the complexities of the doctor-patient relationship to only what is measurable, a series of lifeless numbers out of the context needed to give them real meaning - and a rather expensive series of numbers at that.

Having sent commiser-gratulations to Professor Field, I am now equally torn with what to wish him for the future. Do I wish him well and hope his new role is a success? Or would I prefer he falls flat on his face so that the very idea of a Chief Inspector of General Practice is quietly shelved shortly after the next election?

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68

 

Readers' comments (2)

  • "I try to listen to my patients - I’m not unusual in this, it’s what we GPs do..."

    This is an assumption you make, but where is the evidence for this? If you spend any time on patient forums, you will see that a chief complaint from patients is that many GPs don't listen and don't care.

    "Mystery shopper" assessments where the consultation is covertly recorded would be a better way of rating doctors' communication and clinical skills but this would be costly.

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  • Bob Hodges

    ""Mystery shopper" assessments where the consultation is covertly recorded would be a better way of rating doctors' communication and clinical skills but this would be costly."

    How very Soviet.

    It's all so subjective it's meaningless. I'd be more than happy to introduce an element of patient choice to this - introduce some competition. If patients aren't happy they can change practices.

    Problem sorted.

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