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GPs face scrutiny on death rates

By Lilian Anekwe

Exclusive: GPs face being judged according to the death rates of their patient lists as part of plans being developed to use risk scores to identify potentially dangerous practices.

The Care Quality Commission is drawing up a scoring system so it can target OFSTED-style visits at those practices rated at highest risk.

Pulse has learned the CQC is considering a range of controversial data sources for inclusion in the scores, including mortality rates, patient survey scores and comments about practices on NHS Choices.

All GP practices will need to be registered with the CQC by 1 April 2012, under regulations brought in as a consequence of the Shipman Inquiry, and the commission plans to use Quality Risk Profiles ‘to support monitoring of essential standards once services are registered’.

Use of the Primary Care Mortality Database would allow death rates to be assigned to individual practices or even single GPs, as part of a score to classify practices as low, medium or high risk and potentially trigger tougher or more frequent inspections.

The database was developed after the Shipman Inquiry criticised the lack of independent medical scrutiny of death certificates or routine analysis of mortality data.

But proposals to scrutinise GPs by their death rates will be hugely controversial, because of the wide range of factors other than poor practice or dangerous behaviour that can contribute to high mortality. A study by the University of Leicester found monitoring practice death rates would give only a crude guide, and factors such as care homes would need to be taken into account.

Dr Alex Mears, measurement policy manager at the CQC, said: ‘Our development work is focused on exploring potential data sources for inclusion in a Quality Risk Profile. Among those under consideration are the QOF, hospital episode statistics, the GP Patient Survey and the Primary Care Mortality Database.

‘We’re also able to present qualitative information alongside quantitative datasets, and are looking at sources such as patients’ comments from NHS Choices.’ Dr Mears stressed profiles would only be ‘a prompt to help our inspectors make decisions about regulatory involvement’, and data sources would have to pass ‘stringent tests’ before inclusion.

He said the CQC wanted to produce a ‘visual representation’ of the risk presented by each practice – with practices potentially flagged as green for low risk and red for high, as with PCTs and NHS trusts.

But GP leaders criticised the plans. Dr Robert Morley, a GP in Birmingham and deputy chair of the GPC contracts and regulation subcommittee, said: ‘We can understand the intention of looking at things like this given the tragedies of Shipman. The problem is there seems to have been a knee-jerk reaction to so many things post-Shipman.

‘If it’s analysed properly then there could be some benefit. But I would fear that would not be the case and the wrong conclusion would be drawn.’

GPs face scrutiny on death rates What could the Quality Risk Profiles look like?

• Results for outcome risk estimates displayed on a summary page, grouping outcomes under relevant sections.

• Where it is possible to produce a risk estimate with confidence, results displayed as a coloured dial, designed as a quick method for interpreting risk.

• The dial represents level of risk running from ‘low’ on the left to ‘high’ on the right and the colour ranges from green to red.