They say that a writer should know their audience. When Neil Bacon wrote for The Daily Telegraph recently, it was quite clear from his choice of title that he was not writing for the benefit of GPs. The inflammatory headline, Choosing a GP means gambling with your life – this must stop, is hardly a way to win friends among the profession.
The article, however, raises a serious question about whether or not the Department of Health’s Friends and Family Test should be applied to general practice – something certainly worth debating, although we should remember that Dr Bacon has a vested interest in this matter. He is, after all, an entrepreneur whose company IWantGreatCare.org will be facilitating the test for at least a third of hospital trusts from April 2013 – and I can only assume he would relish the opportunity to do the same for CCGs.
However, I don’t feel threatened by Dr Bacon’s recommendation for the test to be rolled out to primary care. On the contrary, we are currently much more vulnerable to unfair labelling with the current ad hoc feedback arrangement on the NHS Choices website. Most practices have feedback from only a handful of motivated patients who either love or hate the practice, and are in danger of being exposed to extreme views. If all patients were asked the ‘friends and family’ question, I have no doubt that most would answer positively – since this happens time and again whenever patients are surveyed about their own GP.
I have reservations about the Government’s proposal, though. For starters, I hate to see our limited NHS resources being spent on yet more expensive ventures designed to give choice to a sharp-elbowed few, when they could be better spent on improving the care for all.
But the Friends and Family test, applied to primary care, would be especially wasteful because it duplicates what has been happening for decades. Whenever someone needs to register with a new GP, they either don’t really care who they register with and simply pick the nearest practice, or they do care – and they conduct a remarkably efficient and inexpensive piece of research by asking their friends and family. A recommendation from a real person you know and trust will surely always trump a dry scoring system from a website. Even if you are new in town and know no-one, it does not take long to ask around.
Proponents of the test will argue that it is not just about providing choice to patients, but also improving standards. Dr Bacon argues that ‘competition in general practice drives up quality’- and thus betrays a fundamental lack of understanding of how general practice works. Unlike most businesses, the vast majority of GPs are not interested in competing with their neighbouring practices and do not want to expand their business. I may not want half of my practice list to migrate to my neighbour, but neither do I want to have to cope with a large influx of new patients – I already work a 12-hour day. I couldn’t employ more doctors, I wouldn’t have rooms to put them in.
With this in mind, I ask myself where I would want to rank in a league table of local GPs should this test become a reality. My professional pride wants to be at the top but my stress barometer has others thoughts. If the ‘Friends and Family’ test really does influence patient choice, who would want to have their head stuck above the parapet, announcing to all and sundry that they are the best GP in town? Or even the best in their practice?
I suspect most GPs would rather be cosily in the middle of the table, where no-one will notice them and they can get on with their job as before – hardly the driver of competition the Government might envisage.
Anyway, will the GP at the top of the table really be ‘the best’? Our job is not to please patients, but to listen to them, accept them as they are, and try to care for them. Sometimes this will make us popular, but it will also involve challenge, confrontation and being able to say no – skills which may not ensure a good friends and family rating, but are certainly a marker of a good GP.
Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.