Dr Pritpal Tamber reflects on knowledge gaps and where GP commissioners might begin plugging
It’s been a month of knowledge gaps. There are people that know things, people that want to know things, and people that are doing stuff without knowing much at all. The National Audit Office (NAO) rather wonderfully described it as ‘information asymmetry’.
It started, quite appropriately, at the top. Andrew Lansley, the health secretary, was reported to have snapped during some tough questions in the House of Commons, saying: ‘Time does not permit me to explain the extraordinary ignorance of that series of questions!’ I do not know exactly what questions were being asked, but the insinuation is clear: there is stuff he believes he knows, and stuff he thinks the questioner should know.
Of course, such asymmetry may be a ploy. It is not unthinkable that a politician will feign ignorance to make his opponent squirm in much the same way my brother did when we were interrogated about who smashed the window with a crooked right-foot shot (I’m left-footed).
Other asymmetries are more concerning. I am writing this as the Daily Mail headline screams that the Ministry of Defence paid £22 for light bulbs that cost 65p. A more polite form of disquiet was expressed by the aforementioned NAO when they said that providers could save £500m by standardising orders for things like gloves and paper, and by ordering in bulk across a group of trusts. They criticised the lack of coordination between trusts and the fact that there was no practical way to examine the prices being paid by different trusts. A knowledge gap with a £500m cost; imagine the savings that could be achieved with a just a few phone calls.
Other knowledge gaps become apparent when you ask the right questions. A survey of 1.000 GPs in January found that 59% of GPs believed that their commissioning consortia were either being put together or about to be finalised, with 17% of the understanding that their consortium is set up. This is pretty good progress for reforms that are yet to be mandated by a bill, but 35% believed that, in terms of patient population, their consortium would be 50,000. This is pretty small in comparison to the 500,000 that has been suggested by groups like the BMA and the RCGP. Only 15% of those surveyed said their consortium was to be greater than 250,000 making me wonder if these aspiring consortia could have done with more guidance when setting up.
Some groups are doing their best to fill glaring knowledge gaps, notably the Nuffield Trust who recently published a research summary on predictive risk. Most of the models will be familiar to this audience but of note is their intended research into predictive impactability models. We can already identify high-risk citizens (for instance, for readmissions) but impactability models help us to identify the subset in whom preventive care is most likely to succeed. Filling this knowledge gap could help us to better use scarce resources.
Pritpal Tamber is medical director of Map of Medicine
Dr Pritpal Tamber