What did we find?
There was a wealth of insights for individual practices as well as some broader findings for the wider health system. In some cases, we confirmed what most people already suspected, such as a strong link between practice deprivation and both A&E attendance and emergency admissions.
In others we highlighted variations that raised questions for individual practices. Even after excluding outliers where the data was suspect, there was a two-fold variation in the consultation rates for those over 65.
Joining up data sets supported our expectations, such as patients with better continuity of care reporting a better overall experience of the practice. Finally, it helped to put to bed some common myths. Despite politicians insisting that increasing the number of GP appointments will relieve pressure on the wider NHS, there was no indication that practices with a higher consultation rate had lower A&E attendance.
A key issue that we came back to on a regular basis was data quality. It’s not an issue exclusive to general practice, but until practices routinely make use of their data to understand how they deliver care rather than simply ‘feeding the beast’ to satisfy CCG or national requirements, they will not see the consequences of poor coding or inconsistent use of the clinical system. For one practice, the fact that their data suggested they were a massive outlier on hypertension revealed the shortcoming of their coding – and led to an easy way to gain funding they had previously failed to claim. But for many others, their data highlighted that they had given too little attention to ensuring that GPs and other clinicians code accurately. Any system is only as good as the data that goes in.
There are also some real opportunities for improvement:
- Shifting from the quantity to the quality of consultations - activity isn’t always a good thing, but greater focus of offering continuity of care and longer consultations for the right people, probably is
- Managing the workforce in general practice - there are big variations in skill mix and the way practices deploy their clinical teams to meet agreed goals
- The power of benchmarking against your peers - allows practices to ask why they are significantly higher or lower than others on a specific clinical measure
- As well as wider national comparisons - with practices that are ‘most like me’.