GPs could face the publication of individual ‘Ofsted-style’ ratings of their performance after a DH-commissioned study said there was support among patients for the measure.
The study – published today by the Nuffield Trust – says that current measures of practice performance were ‘confusing’ and that easy to understand ratings were needed similar to Ofsted’s, which ranks schools ‘inadequate’, ‘satisfactory’, ‘good’ or ‘outstanding’.
The study was commissioned by health secretary Jeremy Hunt last year to see if a new ratings system could help improve standards of care across the health and social care system.
The Nuffield Trust report concluded that England lacks a comprehensive system for patients to access quality data on hospitals, care homes and GPs. It acknowledged the existence of quality indicators the public could access, for example on the NHS Choices website, but that they were not comprehensive enough, nor did they provide a quality spectrum across England.
The report concludes: ‘[T]here is a big gap here: trying to choose in particular a care home, domiciliary care, or a general practice is not helped by either the confusing array of information from different sources, or more often a lack. This is a space that Ofsted helps to fill in the case of schools.’
‘Perhaps as a result, individuals tend to rely on expert advice from trusted agents such as GPs, and informal sources such as family and friends.’
‘For users, ratings may be more useful for choosing providers that offer relatively simple and more homogenous services, for which they may have more confidence that their own experience can judge, such as general practices, care homes and domiciliary providers as compared to more complex care in hospitals.’
The report, based on consultations with the public, policy-makers, professionals and stakeholders, concluded that the benefits of introducing an Ofsted-style performance measure may therefore help patients choose provider more easily, and could also be used to drive up the quality of providers.
Based on its focus group research with patients, it added that ‘ratings for individual GPs were thought to be more useful than ratings for general practices at an organisational level’.
The final recommendations say the new performance measure would be of benefit for care homes, and could potentially be of benefit to general practices, it was probably not suited to hospitals due to their size and wide range of services, the report said.
The DH has yet to prepare a full response to the report, but a spokesperson said: ‘There is a clear gap in people’s knowledge on how well their services are performing. We know we would need to get any rating system right, but the principle that people should get clear information about quality of services has to be the right one.’
The BMA raised a number of concerns over plans, including that low scoring may demoralise GPs. BMA chair Dr Mark Porter said: ‘It’s important that patients have access to meaningful information about the quality of services.
‘However, there are always going to be problems constructing indicators that measure quality in any meaningful way, and do not result in a target-driven culture.
‘GP surgeries often have many staff and offer a range of different services, the quality of which would be difficult to reduce to a meaningful single score. Any system for measuring performance would also need to take into account the different demographic and financial challenges facing different practices.’
‘Data will only be useful if patients can make sense of it, and if it allows GPs to make improvements. It would also need to be used developmentally rather than punitively – we are concerned about the risk of demoralising staff in organisations with low scores, particularly given the link between morale and quality of care.’
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