GPs must join up to end care lottery, says King's Fund inquiry

GP practices should be opened up to peer and public scrutiny to cut variations in standards of care, according to a two-year investigation of general practice by the King's Fund.

Dr Clare Gerada warned that making practice performance data publicly available could be detrimental (Photograph: Jason Lancy)
Dr Clare Gerada warned that making practice performance data publicly available could be detrimental (Photograph: Jason Lancy)

High-performing practices should be allowed to expand or take over failing practices to drive up standards, the think tank's inquiry recommended.

Most of the care practices provide is good, but there is 'significant scope' for improvement, the inquiry found. It highlighted large variations in clinical and non-clinical aspects of general practice.

GP commissioning, the formation of consortia and practices working increasingly as part of federations, could help to address these concerns, the inquiry concluded.

But general practice will have to adapt 'significantly' to meet future challenges, moving from a 'cottage industry' to working on an 'industrial scale', it warned.

Results of the investigation
  • Quality of general practice good.
  • Wide variations exist in clinical and non-clinical aspects.
  • GPs must be open to peer and public scrutiny.
  • GP commissioning could be platform to improve quality.
  • Practices must operate on 'industrial scale'.
  • Accelerate work to establish federations.
  • GPs should remain generalists.

The inquiry, Improving the quality of care in general practice, highlighted wide variations in referral rates and in the quality of prescribing and diagnoses between practices.

It also found wide disparities in patients' experience in terms of access to care, continuity of care, and patient engagement.

But it said many GPs may not be aware of the variations that exist, and said steps must be taken to address this.

It said transparency and open reporting was 'vital'. The report's author, King's Fund senior fellow Nick Goodwin said: 'Transparency reduces conflicts of interests and allows people to understand the quality of care they are getting. That's the future, there is no doubt about it.'

GP commissioning could not only create a platform to drive improvements in quality, but also to challenge poor performance, the report's authors said.

'GP commissioners need to be given the powers to support, develop and reward practices - but also to challenge, and to penalise where necessary,' they wrote.

General practice will have to operate on a 'more industrial scale' with practices in federations or provider networks, the report argued.

'This is not about sweeping away small practices, but it does recognise the benefits that come from being part of larger organisations or networks,' it said.

The report said generalism must be maintained and instead of developing specialist knowledge, GPs should work closely with specialists in 'multi-professional teams'.

RCGP chairwoman Dr Clare Gerada welcomed the inquiry's stance on maintaining generalism and creating federations.

But she warned that making practice performance data available publicly could be detrimental.

She said: 'It would be much more useful shared within and between practices.

'I also support peer review but it has to be done in a facilitative way.'

Editor's blog: Pressure intensifies on GPs to end care lottery

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