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

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”. This paper represents the culmination of a lot of hard work by our team sending out over 15,000 questionnaires to patients who recently visited a GP in one of 25 practices we have been working with. It forms part of our five year National Institute for Health Research (NIHR) programme grant looking into many aspects of the utility and impact of such surveys (and you can read about the qualitative partner to this paper here).

So what was the point of all this hard work? Well the bottom line is that when it comes down to doctor-patient communication scores of the kind you might see on websites such as NHS choices, there is more variability between the doctors within a practice than there is between practices. At the moment national data on patient experience with general practice in England is only published for practices as a whole. What our work shows is that if you visit one of the best scoring practices in the country, chances are that all the doctors who work there would perform well on such metrics derived from patient surveys. However, if you visit a practice with one of the poorer scores in the country you stand a chance of seeing a good scoring doctor or equally a doctor who might score much less than the practice average.

Given there is so much variation sitting behind the published numbers what should we do about it? Our results suggest that the patient experience scores currently published for general practice may not be a good reflection of the experience patients may have with any one particular doctor, so there may be an argument for collecting the data at individual GP level just as we did. Our experience suggests this isn’t as easy as you might think, but the approach of publishing individual clinician’s data is being rolled out in some hospital settings. At the very least should we let people know that the practice scores may not be representative of individual doctors? If one was interested in identifying poor doctors for quality improvement purposes, rather than informing public choice, it might be possible to use the current national survey as a screening tool for selecting practices worthy of further investigation. Exactly how this would be done or what threshold would be used needs further work, but the possibility exists.

For full details, read the Open Access paper:

Roberts MJ, Campbell JL, Abel GA, Davey AF, Elmore NL, Maramba ,I Carter M, Elliott MN, Roland MO, Burt JA, Understanding high and low patient experience scores in primary care: analysis of patients’ survey data for general practices and individual doctors. BMJ 2014; 349:g6034 doi: 10.1136/bmj.g6034

This work was funded by the National Institute for Health Research Programme Grants for Applied Research (NIHR PGfAR) Programme (RP-PG-0608-10050). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

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