Concerns over public reporting on quality of care in the NHS

November 28, 2002

The public disclosure of information about quality of care is a central component of UK government plans for the reform of the NHS.

A study in this week's BMJ finds that the public and health professionals support the principle of publishing information about general practice performance, but are concerned about the practical implications.

Researchers conducted 12 focus groups with 35 patients, 24 general practitioners, and 18 quality improvement clinical managers in an urban area in north west England and a semirural area in the south of England.

Patients regarded public disclosure as a political initiative and were uneasy about practices being encouraged to compete against each other. They were also more inclined to trust their own experience or that of friends and family than to trust comparative data. One person said: "If I saw my own doctor being slagged off in the Good Doc Guide, I'd still go to him because personally he suits me and I've got faith in him."

General practitioners focused on the unfairness of drawing comparisons from current data and the risks of "gaming" the results, while managers were concerned that public release of the information would encourage a "name and shame" culture in general practice, damaging their developmental approach to improving quality. One commented: "We'll get cover-ups, we'll get further entrenched in our blame culture."

These findings should not derail an initiative that has the potential to improve accountability and stimulate improvements in quality. However, the technical barriers, the antipathy of the general public, the impact on professional morale, and the opportunity costs of focusing on public reporting at the expense of other health service reforms, should not be discounted, say the authors.

A greater understanding of the practical implications of public reporting is required before the potential benefits can be realised, they conclude.


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