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An unflattering view of general practice


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Friday, 5 November 2010

An unflattering view of general practice

A new survey on the quality of care in general practice paints an interesting but not entirely flattering picture of general practice in England.

Perhaps this is why the survey's authors, The King's Fund, are reluctant to describe it as representative and make the more modest claim that it raises "issues for further exploration and debate". 

Their caution is probably unnecessary. If the authors were worried about anyone making mischief with the results, the fact that GPs will soon control two-thirds of the NHS budget will deter all but the most reckless critic.

Respondents rate quality of care in general practice very highly, at an average of 82.5 per cent. As the report asks: "Is this rating something that the profession as a whole should be proud of, or does it suggest complacency?" 

Elsewhere in the no surprises department is the finding that GPs consistently rate the quality of care in their own practices above that of their colleagues. It would be an affront to their professional pride to point out that they can't all be right.

The most potentially controversial area of the survey asked GPs about the quality measures they consider most and least effective. QOF and local enhanced services are at the top end of this scale, patient experience surveys and balanced scorecards at the bottom. Perhaps we should not be surprised to hear that GPs are more interested in the quality levers that reward them than those that measure their performance. 

The King's Fund takes the charitable view that GPs' low regard for "patient experience surveys" may be a reflection of their experience of the existing national survey rather than a sign that they have no interest in the views of their patients. 

Like most surveys, some of the most interesting results of this one are to be found in the comments - the responses to the questions the authors forgot to ask. To do a better job, GPs say they need more time with patients, more GPs, increased resources, peer review, more protected time for learning, and greater opportunities for professional development. 

All of these are inward-looking arguments about greater investment in general practice. Very few respondents mentioned the importance of working with other care professionals and of breaking down barriers to make better use of the resources we already have.  

The survey leaves two impressions - one of complacency, which is hardly unexpected, but another of insularity, which is more worrying.

The Quality of Care in General Practice, published by The King's Fund, is available here.