Chris Lancelot: Quality not quantity is the key to good data

I am increasingly convinced that the NHS desperately needs more information. (No, I haven't lost my senses - read on.)

The GP Record, by Fran Orford
The GP Record, by Fran Orford

Note that I said 'more information' rather than 'more data'. As we all know, the NHS is awash with statistics. We have activity analyses, cost analyses, trends graphs, referral rates, prescribing rates, rates of unscheduled care... you name it, someone somewhere will have measured it.

Managers then make simplistic judgments based on this data. Your practice has a high level of unscheduled care? Clearly you don't look after your patients properly. You are a high-cost prescriber? You must be a lazy clinician. You are an 'outlier' on referral rates? You should be investigated for professional incompetence.

These conclusions may be valid in some cases, but they certainly aren't in others. It doesn't seem to enter managers' heads that a practice with a high level of unscheduled care might be looking after its patients so expertly that, in a night-time emergency, the out-of-hours team (not knowing the patient as well as the practice) feels out of its depth and admits the person.

Similarly, a high-prescribing practice may be keeping its patients out of hospital by using costlier drugs more intensively and a high referrer may be spotting larger numbers of conditions than less skilled colleagues. How can we know which conclusion is right? Only by collecting better quality information. To understand high rates of unscheduled care, we require additional data - the time the care was requested, who sought it and, if applicable, why the attending clinician couldn't manage the patient in the community.

Unsophisticated data isn't helpful if it doesn't allow root causes to be identified. It is expensive and intrusive to collect, and although it may look impressive, it is valueless. Either collect a big enough dataset, or don't collect the data at all.

Without doubt, the NHS of the future will need better targeted and more intelligently analysed information, particularly if it wants to develop cost-reducing strategies and encourage more efficient use of resources. Only when we understand what is taking place can we accurately start changing things for the better.

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