There are better ways to improve the NHS than this online ratings system

When it comes to being treated, patients just want to be made better in the shortest amount of time

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The Independent Online

If you think patient choice in the NHS is a good thing, then two developments this week offer great encouragment: the first is that the Care Quality Commission (CQC) has published for the first time inspection data on all GP surgeries in England – meaning you can look up your own doctor and see how they’re doing. The second is that, also for the first time, patients can compare the survival rates of operations by 5,000 surgeons, via the MyNHS website.

On the face of it, this new transparency is a great step forward. If you are facing a serious operation like heart surgery, you can, in theory, choose the best-performing consultant who, you hope, is more likely to keep you alive. you can bring up the practice details and see information on 38 indicators to judge where the risks lie – on diabetes care, for example.

But once you are armed with the data, then what? I looked up my local practice, a busy surgery in south London, to find it has been rated Band 4, which is pretty good – Band 1 being of highest concern to inspectors, Band 6 the lowest. This information is reassuring, in one way – given the high demand for this practice, I am surprised it was not worse. But then I looked up the indicator for access to appointments, and there is no data – the CQC have just put “value suppressed”. I find this troubling, because if there’s one big problem facing my local practice – and thousands of others across the country – it is access to appointments: earlier this year when I found a lump on my breast I was offered an appointment in three weeks’ time.

I have taken seriously the Government’s advice to go to the chemist rather than my GP with non-serious, non-urgent complaints. But in the six times I’ve been in the past six months, the chemist has suggested we go to the GP anyway – wasting our own time as well as the pharmacist’s.


Yet even if my surgery’s appointments indicator was showing what I think it should show, what would I do next? Do I, as a patient, really have any “choice”? Moving to another practice further away from home would be problematic, but if it meant I could see a doctor more quickly I would switch. Yet, more importantly, if that practice is any good it will not have the room to take on more patients.

As with schools, the word “choice” applied to the NHS is completely misleading. So with the new transparency on surgeons, can there really be any choice where you are to go under the knife? If one surgeon has the highest survival rate and every patient within a 10-mile radius chooses to be operated on by him or her, a huge waiting list would develop – carrying more risk. In any case, as the Federation of Surgical Speciality Associations has pointed out, survival rates for surgeons can be misleading because “very few deaths can be attributed to surgical error alone”.

And then there are the unintended consequences – knowing that their survival rates are being published, would a surgeon be as willing to perform riskier operations?

When it comes to being treated on the NHS, patients just want to be made better in the shortest amount of time. The scandal of GP access is to do with the failure to provide sufficient out of hours appointments – and the Government’s spending of £400m over the next five years may not improve the situation if new doctors are not being trained.

We shouldn’t have to switch, wholesale, to another practice to get better treatment. If the Government wants patients to have genuine “choice”, they should let us get same-day appointments at any GP surgery in our neighbourhood, if we can’t be offered one with our own doctor. That would make GPs more competitive, and the system more efficient. And it would be real choice.


A lesson from Blackpool in the importance of Ts and Cs

As someone who stayed in some pretty ropey hotels in Blackpool for party conferences over the years, I have nothing but sympathy for Tony and Jan Jenkinson, a retired couple who have been fined £100 by an establishment they described as a “rotten stinking hovel” on TripAdvisor.

I hope the Broadway Hotel return the money and gets fined by trading standards for imposing the penalty. But given that the hotel claims its booking documents state explicitly that bad reviews on websites will be charged “£100 per review”, isn’t this also a warning to all of us who blithely tick the box that says “I have read the Terms and Conditions” when we never do?

I never read the Ts &Cs when shopping or booking things online. When there’s something seriously dodgy in the small print, we are complicit by ticking the box.