Results announced on Monday from the Indicators of quality of care in general practices in England review found that the use of composite ratings to assess GP practices would be ‘misleading’ and recommended that proposals to develop practice ‘scorecards’ should be scrapped.
It instead recommended a ‘leaner process for indicator development’, calling for a ‘credible organisation such as NICE’ to consolidate similar quality indicators already provided by groups such as NHS choices and the CQC into ‘comprehensive’ performance metrics.
These could eventually be ‘tailored to different audiences’, possibly with two separate professional-facing and public-facing channels.
The review, commissioned by the DH in June out of health secretary Jeremy Hunt’s new deal for GPs, was carried out by the Health Foundation to explore how indicators could be used to support improvement in care.
GP quality scores
It was initially designed to explore the merits of developing a GP ‘scorecard’ using composite indicators for patients to easily judge the quality of care provided by practices.
But plans for creating an overall scorecard were scrapped, with the DH later agreeing that the review should instead focus indicator development ‘more broadly’.
The review did investigate whether ‘meaningful’ composite indicators to indicate the ‘overall quality of care provided for each general practice in England’ could be developed, but found that these would be ‘misleading’ by ‘masking’ poor aspects of care.
It added that there ‘would be little value’ in publishing a composite score over and above the existing CQC ratings, which could serve to confuse patients, especially if the results were conflicting.
CQC ratings are based on a wider range of information – quantitative data, qualitative data and inspection findings – and are ‘a better assessment of quality’ than composite indicators, it said.
Data available for general practice ‘are not robust enough to provide a credible picture of the quality of care’, the report concluded.
It said: ‘The process of selecting and weighting indicators in a composite would be highly contentious – in particular, decisions about the extent to which an indicator really reflects care provided in general practice.
‘Patients and service users and health care professionals are not homogenous groups. A composite necessarily reflects a range of indicators that have been weighted according to someone’s judgement: an individual patient or service user, or professional, might have preferences for information the composite.’
It also recommended against devising composite scores for care over different five patient population groups – people over 75, children, people with long-term conditions, maternity and the generally well.
It warned that any choice of group would be ‘arbitrary’, with some overlap between groups and some ‘significant gaps’ – such as palliative care.
Lead author Dr Jennifer Dixon, chief executive of the Health Foundation, said: ‘Stakeholders support intelligent transparency, not any transparency. They support development of a set of indicators tailored to their needs, intelligently interpreted and used to help improve care – not for simple judgement.
‘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.
‘However, information alone is not enough. A national quality strategy is also needed to support practices do what they are very motivated to do – make changes for the better for patients. Such a strategy could set a rational path for developing better indicators in the future.’
Photo: Ian Bottle