There used to be an advert on the TV. It involved people growing oranges in the tropics somewhere, and they were waiting for the ‘Man from Del Monte’ to come along and use their produce. “The man from Del Monte come and he say yes,” was the tagline. (I think we can ignore the faint post-colonial whiff of this for now).
Now the phrase ‘the men from Del Monte’ has appeared in the local vernacular to mean a visit expected from a higher authority. We get them quite frequently, and they are of varying quality, depending on who is doing them and what organisation they represent.
The people we have coming to inspect us will include the local university (medical students), the deanery (GP training), the PCT (health and safety and infection control) and also the clinical commissioning group. The meetings requested are becoming more common, and we can expect to add to this list of visitors the Care Quality Commission.
The last visit from the CCG comprised a senior retired GP leading two other visitors. We had a three-line whip to attend this meeting, so all the available partners and salaried doctors did. The CCG team came armed with a sheaf of tables comparing our practice to all of the other practices in the CCG: league tables. In some we showed up well, in others not so well, according to their data.
This is the modern fashion. You measure things that you can measure, and then decide that they tell you things. This will be helped enormously by additional layers of managerial guff and twaddle. They start muttering darkly about the ‘metrics’ and start to cover tables in all sorts of colours.
What does it all mean, then? I’m not really sure, but we had a lively debate about one of the measures they use. The ‘discharge after first outpatient metric’ is a measure that implies that if you refer a patient to outpatients and they do not need to be seen again, then it is a bad referral.
I agreed that could be the case, so we looked at a selected list. It would seem that some patients were referred for reassurance, with specific instructions that they should not need to be followed up. Others were patients we needed advice on so that we could manage their condition in the community (epilepsy is a good example). So the CCG seems to be measuring something and putting it in a league table without it being much help. It reminds me of the comment made about cynics by Oscar Wilde: they know the cost of everything and the value of nothing.
After the visit there was an abiding suggestion that we are somehow less good as a practice than neighbouring practices. I don’t think for one minute that this really is the case, but their data ‘shows’ this. Certainly when the whole process becomes live, we will have increasing pressure to cut costs and ensure that we are not outliers on their little lists.
I have no confidence in the process being able to tell us anything much about our practice. But the fact that some people believe in all this data in these tables is enough to make me anxious for the future use of the information.
After all, information is power. The men from Del Monte may come one day and say ‘No’.
The Jobbing Doctor is a GP in a deprived urban area of England
