Spotlight: When does a ‘poor’ practice mean a ‘poor’ doctor?

Mean communication score (best estimate) by practice and doctor. Practices (n=25) are sorted by their mean communication score.

This was the title of our paper published today in the BMJ when we first submitted it to the journal. However, the BMJ doesn’t allow questions as titles so it became the less sensationalist “Understanding high and low patient experience scores in primary care: analysis of patients’ survey data for general practices and individual doctors”. …read more

The economics won’t go away: NHS Cancer Drugs Fund to consider cost-effectiveness

This week, NHS England published its revised process for operation of the cancer drugs fund.  Of particular interest is the requirement to take into account both costs and effects of treatments. NICE was set up in 1999 with the remit of considering the value for money, or cost-effectiveness of new and existing treatments. It is …read more

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So does QOF really reduce emergency hospital admissions?

What should you make of our latest paper suggesting that QOF reduced emergency admissions? There have now been over 20 systematic reviews of pay for performance (P4P) and even a systematic review of systematic reviews. A reasonable summary would be that P4P seems to improve the processes of care somewhat (and with the potential for …read more

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When incentives go wrong – £55 for dementia diagnosis is a dead cert.

People argue a lot about whether it’s a good idea to give financial incentives to doctors to provide good care. There’s an argument that you should when it costs more to provide that care. Then there’s the more contentious issue of whether a cash incentive is a useful addition. The evidence is that incentives do …read more

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Are patient experience surveys for quality assurance or quality improvement?

Patient experience surveys in primary care carry an expectation that they will stimulate change. Our focus group study in 14 practices explores why practice staff struggle to identify and action improvements as a result of patient feedback alone.

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How can we use patient experience surveys to improve care?

One new answer, for cancer patients, comes from our analysis of the National Cancer Patient Experience Survey, published this week in the European Journal of Cancer Care We found strong inequalities in experience between patients with different cancer diagnoses, and these were pretty consistent across the whole patient journey, from pre-diagnosis care to post hospital …read more

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How do people with diabetes describe their experiences in primary care?

Well, actually quite good news here. People with diabetes in England report primary care experiences that are at least as good as those without diabetes for most domains of care. This is one of our conclusions from our analysis of responses to the English national GP Patient Survey from 85,760 patients with self-reported diabetes. However, …read more

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Cambs CCG gives £800m contract to NHS bidder. Should we all be cheering?

There seems to be general relief that the huge £800m contract which Cambridgeshire and Peterborough CCG have given for integrated care of the elderly hasn’t gone to the private sector. Two of the three final bidders were commercial organisations, but the contract has gone to an alliance between the local teaching hospital, Addenbrooke’s, and the …read more

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Seven day access – policy goes in the wrong direction – again!

Politicians just don’t get it. They are (and have been for years) obsessed with increasing access to GPs. And of course it sounds good for elections. But it’s not what the population needs. Increasing access comes at the expense of continuity of care. You can’t see your own doctor and expect him or her to …read more

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Why has the Welsh government approved Sativa for multiple sclerosis and not NICE in England?

Sativa is a nasal spray based on a cannabis extract which is used for painful muscle cramps in multiple sclerosis. There doesn’t seem much doubt that it works, and in its most recent draft guidance on MS, NICE has based it’s decision on cost effectiveness grounds – the benefit came out at £49,300 per QALY …read more

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  • The Cambridge Centre for Health Services Research (CCHSR) is a collaboration between the University of Cambridge Health Services Research Group at the Institute of Public Health and the Health and Healthcare Group at RAND Europe. We aim to inform policy through evidence-based research on health services in the UK and internationally.