I will pull this apart later but, in short, it's a load of b*ll*cks.

On the face of it, it seems reasonable. But the biggest problem tends to be getting appointments and is something patients have grief with so it wouldn't surprise me that most surgeries will score low.


Another load of b*ll*cks that basically means those who shout the loudest will be heard and these are usually the disgruntled patients who have issues in other walks of life.


Which is a big thing. Some surgeries serve a population that is almost all on benefits, have drug/alcohol problems, domestic violence is rife and these people go to the doctor for everything because the Govt has made us the first port of call for patients. Other surgeries have a demanding population who want everything at the drop of a hat. They expect the red carpet to roll out for them. These are people who if they aren't 100% satisfied will just mark everything down.


We shall see.


How do you measure the performance of a GP? Will come back to this later.


Not necessarily. It'll just highlight which areas have patients that are most disgruntled/unhappy.


Load of b*ll*cks. That's like having only every been in one car and driven that same car but still able to comment on other cars despite never having seen/travelled in/driven one. Unless you have been to several practices, you can't comment on the idea of what it's like to be a patient at each surgery.


Again, a lot of this is down to patients unrealistic expectations.

In my next post, I'll go into more detail

I would give extra points if the doctors or nurses were hot.

So how would you do it?
Are doctors so sacrosant that they can't be rated?
At the moment it is all down to word of mouth whether a surgery is any good.
Shouldn't patients have some way of seeing an assessment of his good a practice is?

I have no qualms about assessing how good a surgery is but have issues with the way they are doing it.

I've worked in several GP surgeries and I've been a patient in a few different surgeries so I feel I have a better overview than some.

My own surgery, for example, is right across the road from me. But getting an appointment is horrendous. Because of the local population (largely ethnic minorities and on benefits, or elderly/disabled), they've gone for a system that means you have to ring up on the day to get an appointment. There are no advanced appointments. The two times I've needed to see a doctor, I found it easier to pass on a message for them to contact me and book an appointment that way. It's a bit unfair that I can get around the system, I agree but it's even more unfair that I even have to. However, despite having in the order of 8-10 doctors, it's the only way they can manage things.

The surgery I work at is located in a posh area. The patients tend to be business managers/solicitors/dentists ie high-end professionals. These people are used to getting their way as soon as they snap their fingers. For them, it's inconceivable that I'm running even five minutes late. In a patient participation group, they wanted us to provide a free coffee machine in our surgery! Our appointment system is such that half of all appointments each day are book-on-the-day. The other half are book-in-advance. This means if you ring up on the day before a set time, you are guaranteed to be seen the same day by a doctor. This ordinarily should be enough but patients here don't like that. They want to see a specific doctor at a specific time and if it's not convenient to them, they're not happy. There are usually enough slots to book and see a doctor up to a month in advance so if it's not an urgent problem, it can be dealt with at any point in the next four weeks.

The entire point of the above is that both practices would score lowly but for different reasons. Compare this to a colleague who works in the sticks and the patients are grateful just for being seen and very apologetic to have troubled them. They have no qualms about him running an hour late or even cancelling a surgery! Yet this practice would score highly despite providing a poor service in comparison to the practice I'm working at. This is the crux of what I'm ranting about and why I disagree.

As a trainee, my performance is closely monitored. I have to get patients to fill in a questionnaire. I have to get all staff members to fill in a questionnaire. It's all anonymised. My trainer has to do an evaluation on me. In short, I'm assessed from multiple angles as to whether I'm fit to work as a fully-fledged GP or not.

IMO, the scoring system is more a reflection of the patients than it is of the surgeries. I've previously that some patients have no idea of other surgeries. They've got no benchmark to score anything else against. How does their score get counted? We've had multiple patients who've been unhappy with the service that we provide, bugger off elsewhere, only to return because the other surgeries are poor in comparison. Yet they wouldn't have known that if they hadn't moved.

Certainly, things like manners, explanations etc are things you can probably measure by comparing to other GPs in the practice.

My other issue is how were the questionnaires designed and how were they distributed? I don't recall ever receiving a questionnaire. So was it done in-house at the practice? In which case, was it a fair representation of the population they serve? Anecdotal evidence suggests the ones who are most likely to fill out questionnaires are the ones with an axe to grind. This then provides a very polarised view of the practice. It would be better for everyone to fill in the questionnaire but what about those who don't ever go the surgery?

Furthermore, the expectations and demands placed on GPs and surgeries these days are unrealistic. Nobody seems to be able to manage a cold any more. I've lost count of the number of times a patient has told me about their pain but then reveals they haven't taken any painkillers. There's also the demand that people expect to be miraculously healed instantaneously. A week for a cold to go away? No that's far too long! You must be able to give me something to make it all go away, Doc.

I blame this inappropriate health-seeking behaviour on two things: modern consumerism and the RCGP. When you have 24 hour shopping, and instant gratification, people want 24 hour access and instant relief. My concern is the attitude now is of not allowing people to grow old and no one being allowed to die because they're 92 years old. We're criticised if they do! The RCGP on the other hand has trained us to explore patients' ideas, concerns and expectations (ie all the soft stuff). Because of this, I'm now the shoulder people come to cry on. Suddenly, instead of trying to help their healths, I'm being involved in peoples' lives. I'm being asked to mediate in family arguments. Seriously, WTF?!?! There needs to be a move towards people trying to manage themselves rather than relying on other people. I think we as a culture have now gotten to the point where we can't depend on ourselves, we can't help ourselves and instead of moving onwards and upwards, we're regressing to the state of children.

So once you've passed that's it for patient input.
You've out forward an argument why the rating system put forward won't work but no alternative. A rant is good i do it all the time
But you have to be careful or you will sound like so many of the healthcare professional representatives who seem to disagree on any proposal almost on principal but never seem to offer anything productive.

Sorry, I'm trying to bits of work in between posting on here.

No. The practice I'll be working at has a patient feedback form and questionnaire once a year. We also have a patient participation group where any patient can come and have a chat about things. They are made aware it's not a chance to have a rant but constructive feedback. Sometimes we do get silly things like coffee machines, but other times it can be useful eg arrangement of chairs in the waiting area.

As for the scoring system, a better system would be to get everyone over, say, a 6/12-month period fill in the questionnaire - gives those who don't attend often a chance. But the running of the practice would also be scrutinised. Example - patients say they can't get through to the telephones to make an appointment. Is it because the receptionists are chatting away? Is it because there are so many people trying to phone in? If patients say they can't get an appointment, is it because they wanted to see a particular GP who happened to be away on annual leave? Or is it because they just wanted to be seen immediately for a non-urgent problem? There are two sides to every story and this scoring system provides only one side.

I think a proper system would give an accurate reflection of the practice but my concern is that it would be too financially/administratively burdensome to do that nobody bothers to do it properly.

Surely then, if different areas were scored, you could see that in surgery X patients thought booking an appointment was poor. You publish this stating that "Patients at Y% happy with booking appointments". Someone then go to the surgery and sees why it's hard to book, and publishes that as well.

Publishing the cause and response would allow surgeries to try and improve while also letting patients know why the problem is occurring.

I've found that on the trains, passengers are generally happier to be delayed if they know why they are being delayed. Some people will still complain, but more people complain if they don't know why...

I couldn't see any 0-10 scores for my surgery, just one review calling the staff racist.

Well, they don’t seem to give any lee-way on this criterion with schools, so why should GP surgeries be any different? Make people better, and fast. Death is not an option.

The problem with this is that if a surgery has problems with bookings, you need to remeasure once they've taken any remedial action. Which then spirals the cost. The other question is how up to date the information?[/quote]


Which is going to be typical of the responses - those who have an axe to grind will be the ones who respond to the questionnaires.


My concern is that they won't necessarily adjust for the differences. The main difference with surgeries and schools is that quite often you have no/limited choice of surgeries. I used to go to a secondary school that was 10 miles away. There's no way a surgery would accept patients this far out.

Once the data is collected, the rest is down to statistics and interpretation. Your surgeries won't be compared (by anyone who's opinion counts) individually against dissimilar peers. so nobody will look at your score - serving well heeled but irritable clients and say you are bad because another surgery tending to farmers has a higher score. And I'm sure an analytic method will be used to even out the effects of the nutters.

The inferences to be drawn will include general facts about certain types of environment and the attitudes that pertain within them. So we will have tons more stats available about consumer attitudes to healthcare than before. Any effect on your personal career will surely be interpreted against this backdrop of relevant information about how grumpy your wife beating alcoholic neighbours are expected to be with their doctors, and how fussy your corporate raiding head hunting advertisers are expected to be about you.

And the handful of consumers who will put this information to practical use when choosing a surgery will do what I did when I looked at the online reviews for local GP surgeries a few months ago, which is think about how awful all their child stabbing, beer stealing, wife immolating fellow citizens are, and take their opinions with a pinch of salt.

i couldn't agree more
there are lies, damned lies, statistics and then Govt. statistics ...