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Inquiry challenges politicians to rethink how to judge GPs

By Lilian Anekwe

Exclusive: A major inquiry into general practice will reject the Government’s obsession with crude numerical measures of access, and recommend GPs are judged by their ‘therapeutic relationship’ with patients.

Pulse has learned that the King’s Fund Inquiry into general practice – an 18-month, wide-ranging investigation into GP care – will challenge the political consensus surrounding the push for extended hours and workplace convenience.

As Britain goes to the polls, inquiry panel members said they would seek to reshape the new government’s perceptions of general practice, by delivering ‘a completely different way of looking at performance management’ that gives far more weight to continuity of care.

The first details of the inquiry’s findings follow Pulse’s report last week that PCTs were ordering a wave of closures of small practices, amid concerns they would struggle to meet the challenge of extended access.

Yet this week it emerged that a patient consultation by NHS Kingston in south-west London, conducted as part of the trust’s plans for polysystems, found patients rated continuity of care as far more important than access close to work or extended hours.

Members of the overarching inquiry panel for the King’s Fund’s investigation, which is due to report on GP access in June, told Pulse they were drafting measures to ‘capture the spirit of general practice’.

These will include the therapeutic relationship that individual doctors form with patients, whether patients can choose to see a particular GP and if specific requests can be met, such as availability of a female GP or one who speaks a particular language where there are large numbers of ethnic minority patients.

There will also be indicators for how easy a practice is to travel to and whether there is suitable parking, and potentially for areas of clinical performance that fall outside the QOF, such as cancer care and acute illness.

Professor Martin Roland, inquiry panel member and professor of health services research at the University of Cambridge, told Pulse: ‘The focus of NHS policy has been increasing access. A number of things have made it difficult to get continuity of care – practices have become larger, more specialised and with rapid access. We need to redress that imbalance.

‘The inquiry intends to identify things important to measure like continuity of care, which has not featured greatly but matters a lot to patients and GPs.’

The inquiry aims to produce a comprehensive report on the quality of general practice, incorporating 10 separate research projects in areas such as access, inequalities, continuity of care and the quality of diagnoses and referral.

It is set to criticise the patient survey, balanced scorecards and the RCGP’s practice accreditation scheme, and recommend avoiding duplication between them.

Dr Michael Dixon, panel member and chair of the NHS Alliance, said: ‘Balanced scorecards are notoriously unbalanced because they are skewed by the motivations of the people who set them. It’s a number-crunching exercise that demotivates and demoralises and leads to alienation.’

Dr Nick Goodwin, project director for the inquiry, said measuring quality was ‘going to be increasingly on the political agenda’.

‘We will probably suggest allowing GPs to self-reflect on quality, but with recommendations to regulators on how to invest in that process.

‘Measuring quality is going to be increasingly on the political agenda. Ps need audit data to help them judge themselves against their peers.’

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– Scrap patient survey targets
– Stop fragmenting primary care

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Professor Roland: ‘NHS policy has focussed on access – we intend to redress the imbalance’