Exclusive: GP anger over 'unfair' diabetes league table

GP leaders have called for a Public Health England (PHE) league table for diabetes care to be scrapped, amid concerns that huge gaps in data in many areas had skewed CCG scores.

Blood pressure: management part of diabetes care indicators (Photo: JH Lancy)
Blood pressure: management part of diabetes care indicators (Photo: JH Lancy)

PHE launched the Healthy Lives online tool last week, which ranks practices and CCGs in an online league table based on the quality of diabetes care they provide.

But GP can reveal the dataset behind the tool is based on incomplete data, with scores for one in five CCGs based on information from less than half of practices in the area.

GP leaders warned that using ‘half-baked’ information ‘completely discredits the value and merits of the process’, and urged PHE to admit it 'got it wrong'.

Among several care measures, the tool ranks CCGs based on the proportion of patients with diabetes who meet all treatment targets for the condition.

Data is not representative

It uses data collated by the National Diabetes Audit (NDA), which annually measures the effectiveness of diabetes healthcare and relies on practices self-reporting their data to do so.

Although this data was previously available online, the new tool – according to the Healthy Lives website – ‘marks the first time they have been published in this form making information easy to access, view and compare CCGs, local authorities and general practices’.

But of the overall CCG scores represented in the ranked table, 37 of 211 (17%) are made up of data from less than half the practices in the area. Five of them, including Tower Hamlets CCG, have their score based entirely off data from just one practice.

Only 66 of the CCG scores are based on data from over 90% of the practices in the area, suggesting the vast majority may not be accurate representations of the area’s performance.

PHE removes data

Tower Hamlets CCG initially appeared to have the lowest overall figures for meeting diabetes targets out of all CCGs in England, but PHE has now removed its data following objections raised by the CCG.

A spokeswoman from the CCG told GP: ‘Only one GP practice in Tower Hamlets filled in the return, so the stats were completely invalid because they only represented one out of 36 practices, which isn’t really fair.

‘One of the things that we’re really proud of in Tower Hamlets is our really good stats on diabetes management. We perform really well on the seven different measures for diabetes, and we are top for three of them. Overall we’re above average, so it was a bit of shock to see that.’

But its data was only removed after the tool received national media coverage, with many news outlets highlighting Tower Hamlets as being the worst provider of diabetes care.

No confidence in data

GPC deputy chairman Dr Richard Vautrey said it was ‘clearly not fair’ to build a league table on incomplete data and suggested it should not remain online if this was the case.

He said: ‘Whenever you create league tables they are hugely sensitive. And, as with any performance management process that’s done in the public domain, those creating it have to be absolutely confident that they have got accurate information.

‘There's no point having information up there if it’s half-baked and I think people won't have confidence in the information if they can't be certain that it’s accurate and valid.’

PHE said it had now implemented some changes following feedback, which included colour coding some CCGs as grey to indicate very low participation rates from practices, instead of green or red to represent above or below average performance.

PHE’s director of knowledge and intelligence Dr Julian Flowers said: ‘Following feedback, we have made improvements to how the tool displays data from CCGs who have submitted a small sample size to the NDA audit to avoid misinterpretation of their ranking within the tool. Healthier Lives is continually evolving and we encourage all feedback to ensure the tool is a valuable resource to healthcare professionals, commissioners and the public.’

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