The Government plans to push ahead with its controversial ‘information revolution’ across public services by releasing a raft of comparative data on GP performance, including prescribing rates and clinical outcomes.
The proposals – published today – come as part of the Government’s move to release huge amounts of data about public services in order to make them more transparent and accountable. But the scheme has run into opposition from GP leaders who warned it could mislead patients if it is too ‘simplistic’.
GP data will begin to be published online by December, with members of the public able to compare practices on prescribing data, staff satisfaction and comparative clinical outcomes, with indicators to be drawn up in cooperation with the RCGP.
NHS medical director Professor Sir Bruce Keogh told Pulse that his ‘personal inclination’ was for the data to be published on the NHS Choices website which already list practices and allows patients to review services.
Prime Minister David Cameron said: ‘Transparency is at the heart of our agenda for government. We recognise that transparency and open data can be a powerful tool to help reform public services, foster innovation and empower citizens.’
‘We also understand that transparency can be a significant driver of economic activity. These commitments represent the most ambitious open data agenda of any government in the world.’
But GPC deputy chair Dr Richard Vautrey told Pulse: ‘It can be helpful to provide more information about health services but for the information to be really meaningful the local context of practices needs to be fully understood to be able to interpret the information appropriately.’
‘We should also be clear that measuring areas that can be measured misses so much about the importance, richness and real quality of general practice that patients value. General practice cannot be reduced to a simple list of measurable statistics – it is far more complex than that.’
GPC chair Dr Laurence Buckman said ‘simplistic’ league tables could mislead the public.
‘Publishing GP practices’ prescribing data without the context of the demographic of the population would make it impossible for people to interpret the information appropriately.’
‘Similarly, comparing the clinical outcomes of GP practices would need to be done in a way that is fair and compares like with like – rates and outcomes for chronic bronchitis, for example, can differ markedly depending on the lifestyle and even the occupations of the local population.’
‘While greater transparency is a good thing, it must be both appropriate and meaningful and that generally means context is important,’ he added.
Professor Keogh responded to these criticisms by telling Pulse: ‘I have spoken to Laurence Buckman to ask him where the GPC is on this and Laurence is up for it but he doesn’t want people to invent new data that has to be collected, and I agree with that 100%. He was also keen that the RCGP are at the forefront of developing this and that is right and I have talked to Clare Gerada about this.’
He added that in his experience of doing a similar data publishing exercise with heart surgery units it was possible to contextualise data to take account of factors beyond the control of clinicians. The effect had been to reduce mortality rates by 20% in just a few years, he said.
The Department of Health said it was following the lead of NHS London, which has agreed a set of 22 indicators with Londonwide LMCs for public consumption (see below).
Dr Howard Freeman, associate medical director of primary care at NHS London and a GP in south west London, welcomed the Government’s plans to keep GPs under the public’s ‘watchful eye’.
He added: ‘We are working with the Mayor’s office, Londonwide LMCs and GPs across the capital to give as much useful information as possible to the public.’
London’s 22 GP outcome standards
The following set of outcome standards were agreed with GP leaders in London in April. They are split into both practice and consortium indicators.
1. One year cancer survival rates for breast cancer and lung cancer (consortia indicator)
2. Cancer prevalence (consortia indicator)
3. Cervical screening
4. GP recorded smoking (Whole population)
5. GP recorded smoking (Long-term conditions)
6. Atrial fibrillation prevalence (consortia indicator)
7. Immunisation uptake
8. Influenza immunisation uptake (both practice and consortia indicator)
9. Chronic obstructive pulmonary disease (COPD) prevalence
10. Asthma prevalence (consortia indicator)
11. Diabetes prevalence (consortia indicator)
12. Coronary heart disease prevalence (CHD)
13. Dementia prevalence (consortia indicator)
14. Monitoring safe, rational and cost effective prescribing in general practice
15. Emergency hospital admission rates for specific chronic conditions usually managed in primary care (consortia and practice indicator)
16. A&E attendances (consortia and practice indicator)
17. After consultation how well did you understand / feel better able to cope?
18. Satisfaction with overall care received at surgery
19. Patients changing practice without changing address
20. Ability to see a specific GP or Practice Nurse if wanted
21. Advanced appointments. Satisfaction with opening hours. Ease of getting through on the phone
22. Significant event reporting (One and three year targets) (consortia indicator)