RCGP Chair, Prof Kamila Hawthorne has written to Health Secretary for England Steve Barclay outlining the dangers of publishing practice-level data in terms of allowing arbitrary comparisons between practices that fuel anti-GP rhetoric in the media and damage the relationship between practices and patients. This has been featured in The Times and Prof Hawthorne discussed it and wider issues facing general practice on BBC Radio 4’s Today Programme this morning. The full letter can be read below:
Dear Secretary of State,
I became the new Chair of the Royal College of General Practitioners last Saturday and feel compelled to write to you in light of the appalling anti-GP rhetoric that was stirred up by the release of the GP practice-level data yesterday (November 24).
The RCGP has consistently raised concerns that the publication of such data could be used to create division between practices and patients, and this is already happening. The data is being inappropriately interpreted and used to name and shame practices, without understanding or consideration of their circumstances or reasons for operating in the way they are doing so.
There was a ‘good news story’ about general practice yesterday, however it was largely ignored or deliberately overlooked. GPs and their teams delivered a record 36.1 million consultations in October this year alone, almost 40% of these on the day they were booked and more than 71% delivered in-person, the highest proportion since before the pandemic.
We understand that the publication of practice-level data is included in the GP contract and the Government’s Plan for Patients, but we are concerned that it may have the opposite effect of their stated aim to improve patient care and increase choice. For example, practices may feel they have to stop allowing patients to book regular checkups weeks in advance, or ask patients to travel to the practice – leaving work or caring responsibilities – where it could have been done remotely.
We have major concerns about the quality and accuracy of this data and there are clear anomalies. NHS England itself has said the data is experimental and should not be taken too seriously, but two media outlets have created tools for patients to compare practices in their locality, which do not take into account the many nuances in how general practice operates, or limitations of the data itself.
GP practices work in different ways to account for differing patient numbers, demographics and needs – they cannot be compared like for like. This data, as presented, is not helpful for patients in making informed decisions about their care and causes patients to lose confidence in their GP. Below we have set out further details of our concerns:
The value of remote care
We must move away from the prevailing narrative adopted by some politicians and parts of the media that remote care is ‘bad’ and in-person care is ‘good’. The Department of Health and Social Care and NHS England are both advocates of better use of technology in the NHS, including in general practice, but allowing this data to be published, in full knowledge it will be used in the way it has, undermines this. Good, safe and appropriate care can be delivered remotely, and where in-person care is necessary it is being delivered. Indeed, as the data shows, in October 71.1% of appointments in general practice were delivered in-person.
Many patients find remote consultations convenient, and they can improve access where patients would otherwise struggle to get time away from work or caring responsibilities. There is a real danger that practices will start to reduce the chance for patients to have a remote consultation because of fear that they will be named and shamed in the press.
Time between booking an appointment and consultation taking place
No patient should be left to wait two weeks for an urgent appointment. Unfortunately, the way statistics are currently published this appears to be happening much more than it really is.
The notes published alongside this data states that reasons why practices may differ include patient availability and regular/repeat appointments that may be booked in advance. This leads a ridiculous situation where practices are shamed in the press for allowing patients to book regular health check-ups or follow-up appointments in advance. This could lead to a situation where patients are told they must phone up on the day or week of their appointments to book these types of appointments.
Percentage of patients seen by a GP
The expansion of additional roles in general practice has been one of the successes of this government’s NHS policy. While important challenges remain with integration of new staff, patients have benefited from seeing a wider group of staff in general practice, including pharmacists and physiotherapists, which widens the services offered to patients. It is important that there is a clear message from government that patients are not ‘short-changed’ if they see another member of the team rather than a GP. Indeed, for some presentations it may be better.
General practice is operating under intense pressures. The 36m appointments delivered in October is the highest on record and this does not account for the increasing complexity of general practice work; yet numbers of full-time, qualified GPs have fallen since your government promised to deliver 6000 more in your 2019 election manifesto.
The creation of league tables does not improve performance, and this data is not high enough quality or suitable to be used in order for patients to compare practices.
I am very keen to meet with you and work with you. We need to discuss how we can improve patients’ experience of general practice, including looking at how we could improve transparency and patient choice, without publishing misleading statistics which may well have the exact opposite effect.
Professor Kamila Hawthorne, Chair RCGP
Amanda Pritchard, Chief Executive Officer, NHS England
RCGP Press office: 020 3188 7633
Notes to editor
The Royal College of General Practitioners is a network of more than 54,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.