Exclusive: GP ‘scorecard’ would be 'divisive', says report

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The use of single ‘scorecard’ type metrics for measuring performance in general practice would be misleading and divisive, a Department of Health commissioned report has concluded.

DH commissioned report finds “composite” ratings for GP performance would be misleading
Breaking indicators into those for population groups would be “arbitrary”
Report authors recommend consolidating existing GP data websites

The Health Foundation, which authored the review into GP quality indicators, said that single “composite” indicators aggregate information, which can mask “specific aspects of the quality of care, falsely reassure and thus be misleading”.

Jennifer Dixon said ‘nobody supported’ a single performance measure

The think tank’s chief executive and report co-author Jennifer Dixon told HSJ that even if national bodies wanted to establish such a simple performance measure, it would not work as sufficient data is not available.

Dr Dixon said: “We thought there would be somebody who would argue the case for a more reductionist set of measures that could be rolled up into a composite, but nobody supported that at all.

“Even if you wanted to, it just wouldn’t work. The data on general practice just isn’t there at the moment.”

Health secretary Jeremy Hunt has previously proposed the introduction of a GP “scorecard”, but this was strongly criticised by some GPs, the British Medical Association and the Royal College of GPs.

The authors added that the term “scorecard” was “divisive”, and recommended avoiding the term if a key purpose of compiling performance metrics was to improve care.

The report, published today alongside research by the King’s Fund into clinical commissioning group performance indicators, found that creating a small set of headline GP quality indicators could be valuable for the public. However, it said that publishing a composite score separate to existing Care Quality Commission ratings could confuse patients.

It also dismissed the idea of creating indicators for particular population groups, such as those over 75, which had been floated by Mr Hunt, as “arbitrary”. Instead it recommended a tool be created to allow users to self-select indicators of interest to them.

The review does, however, encourage the development of “vital signs” indicators for accountability purposes.

This would involve a relatively small group of indicators to help national bodies determine where improvements should be made. The authors warn against using such measures to “rank” practices.

The report also recommends the “careful” consolidation of a number of existing online resources where indicators on the quality of care in general practice are published. One option to consolidate websites, it adds, would be to make the MyNHS website specifically for NHS professionals. Meanwhile, the more widely used NHS Choices site could serve as a “public facing” resource for GP indicators.

The review further advocates the development of a “national quality strategy” for general practice, and primary care more broadly.

Such a strategy, the authors said, would “give focus to improvement activity and indicator development to serve intelligent transparency”.

Mr Hunt is expected to address the recommendations shortly. A DH spokeswoman said: “We are determined to make our NHS the safest healthcare system in the world. Improving transparency and using data are key to achieving this and we are pleased to see both the King’s Fund and the Health Foundation endorse this approach.”