There has been an understandable amount of disquiet over the re-hashing of old data from QOF, the GP Patient Survey, prescribing patterns and hospital admission statistics by CQC – now presented as the banding of surgeries from one to six. But the argument of how one measures good health care seems to have been side-stepped.
No-one really knows what makes a good doctor. Each medical school has a slightly different syllabus and teaching style because there is no true way to measure the effectiveness of each one, or what a good doctor is (apart from not being struck off).
Furthermore, I’m not sure there is evidence that patients’ opinions of doctors is an accurate correlate with good clinical practice. For example I am led to believe that Harold Shipman’s patients thought that he was a good doctor and perhaps he would even have passed the Family and Friends Test, his CQC inspection, and his revalidation, the lot. I don’t know of any proof that patient satisfaction means that one is a good doctor.
The trickiest issue for those GPs like me who complain about arbitrary measures of ‘clinical effectiveness’, be they the QOF, CQC inspections or any one of the enhanced schemes, is whether we need to provide a viable alternative to CQC inspections, data extractions and public floggings.
I agree that there needs to be a robust and alternative way of identifying practices that are not providing a good clinical service, but I accept it’s not clear at the moment what that might be.
Appraisal and revalidation have been set up to scrutinise individual doctors and identify those who pose a risk to their patients (and whether it is appropriate or works is another debate for another time).
Similarly, inspection of practices by CQC seeks to ensure that they meet requisite standards of high quality care. But I don’t think either of these systems are the right mechanism for measuring GPs’ success.
For a start, I don’t believe we have nailed down what quality care actually is, let alone whether there is evidence that it can be effectively and accurately measured, or how harmful using a tick-box, data-extraction methodology to measure quality is to doctors. This very process is often cited as part of the reason GPs are leaving the profession in droves.
A friend told me that the local LMC is well aware of practices in the area that are struggling or who are not performing as well as comparable nearby surgeries. He argues that a measuring scale for identifying such practices is not required – and I agree that there should be an alternative way for struggling practices be identified, investigated and helped to turn things around.
Currently the CQC threatens failure to meet their ‘standards’ by taking away a practice’s CQC registration or its contracts with NHS England.
But we’re struggling for GPs as it is. We must come up with a better alternative.
Dr Samir Dawlatly is a GP in Birmingham.