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Government ‘must abandon simplistic GP ratings’

GP leaders back two independent reviews that reject ‘GP scorecards’ as meaningless

Louise Prime

Tuesday, 13 October 2015

Common sense has prevailed, according to GP leaders, as the latest investigations into how best to measure quality in the NHS have ruled out a ‘GP scorecard’. They called on the government to pay attention to the outcome of the independent reviews – which strongly advised against making a composite score out of selected indicators in a misguided attempt to provide an overall rating for care quality, because this can mask areas of good or poor performance – and to rapidly abolish simplistic ratings for practices.

The Department of Health asked the Health Foundation* to review quality of care indicators in general practices in England, and commissioned The King’s Fund** to review how to assess the performance of local health systems; both reports are now published.

The Health Foundation told the government that it had found considerable support among those working in general practice for publishing meaningful information on quality based on a tailored set of indicators, rather than simple overall judgments. But it pointed out that information in isolation is not enough. The charity’s chief executive Dr Jennifer Dixon said: “Stakeholders support intelligent transparency, not any transparency … The indicators we have at the moment are not robust enough by themselves to give a credible picture of the quality of care, especially care which is as heterogeneous as that provided by general practices.”

The report recommended:

  • The DH should consolidate the multiple existing websites currently sharing information about general practice quality
  • It strongly advised against making a composite score out of selected indicators to indicate the quality of care overall in general practice, or for particular population groups.
  • A small set of indicators should be developed, potentially by the National Institute for Health and Care Excellence with others’ support, showing the information that matters most to the public, health care professionals and those accountable for the quality of general practice.
  • A national strategy should be developed to improve the quality of general practice and primary care; this should guide indicator development, with annual reports on progress.
  • Those working in general practice must be given support on how to understand and use information to improve patient care.

BMA GP committee chair Dr Chaand Nagpaul responded: “It is encouraging that this report confirms the BMA’s view that the services GP practices provide are far too complex to be arbitrarily reduced to a single ‘quality’ measure. As we have seen with the Care Quality Commission’s troubled inspection regime, it is not transparent to present a range of quality measures in populist categories without context, and which can be misleading for patients and professionals. We endorse the Report’s rejection of ‘scorecards’, and agree that data should be used in a learning environment to support improvement, as opposed to erroneously judging practices.”

He called on the health secretary “to listen to this report and the BMA, and rapidly abandon the concept of simplistic ratings for GP practices”.

Chair of the Royal College of GPs, Dr Maureen Baker, concurred. She said: “We are pleased to see that common sense has prevailed … The purpose of such data should help clinicians to improve the care they give to their patients, it must never be used to judge or performance manage them.”

The King’s Fund pointed out in its report that an aggregate score can mask good or poor performance on individual indicators and so not be a meaningful picture of performance. It called for “radical simplification and alignment” of the approach to performance assessment in the NHS, including consolidation into a single framework of the three national outcomes frameworks.

It recommended providing publicly available information at three levels of detail: first, a small set of headline indicators to enable the public to assess how the local health system is performing; second, a broader group of indicators based on existing frameworks; and finally, a more detailed set of indicators to provide as comprehensive a picture as possible of local health system performance, allowing commissioners and providers to assess the quality and effectiveness of local services and identify areas for improvement.


* Dr Jennifer Dixon, Emma Spencelayh, Anna Howells, Abraham Mandel, Felix Gille. Indicators of quality of care in general practices in England. An independent review for the Secretary of State for Health. The Health Foundation, October 2015.

** Chris Ham, Veena Raleigh, Catherine Foot, Ruth Robertson, Hugh Alderwick. Measuring the performance of local health systems. A review for the Department of Health. The King’s Fund, October 2015.

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