GPs could be judged on patient death rates

25 November 2010

GPs could be judged according to patient death rates as part of plans to identify high-risk practices.

The Care Quality Commission is drawing up a scoring system so it can target potentially dangerous practices, Pulse newspaper has claimed. They reported that the CQC is considering using various data sources in the system, including mortality rates, patient survey scores and comments about practices on NHS Choices.

All GP practices must register with the CQC by April 1, 2012 under regulations brought in following the Shipman Inquiry. Pulse reported that the commission plans to use Quality Risk Profiles to “support monitoring of essential standards once services are registered”.

Use of the Primary Care Mortality Database would allow death rates to be assigned to individual practices, or even individual GPs, as part of a score to classify practices as low, medium or high risk. The score could then trigger more frequent inspections. The database was developed after the Shipman Inquiry criticised the lack of independent medical scrutiny of death certificates or routine analysis of mortality data.

Dr Alex Mears, measurement policy manager at the CQC, told Pulse: “Our development work is focused on exploring potential data sources for inclusion in a Quality Risk Profile. Among those under consideration are the QOF, hospital episode statistics, the GP Patient Survey and the Primary Care Mortality Database.

“We’re also able to present qualitative information alongside quantitative datasets, and are looking at sources such as patients’ comments from NHS Choices.”

Dr Mears stressed that profiles would only be “a prompt to help our inspectors make decisions about regulatory involvement”, and that data sources would have to pass “stringent tests” before inclusion. He said the CQC wanted to produce a “visual representation” of the risk presented by each practice – with practices potentially flagged as green for low risk and red for high.

But there are fears that monitoring GPs’ death rates would provide only a crude indication of a practice’s performance.

GP Dr Robert Morley, deputy chair of the GPC contracts and regulation subcommittee said: “We can understand the intention of looking at things like this given the tragedies of Shipman. The problem is there seems to have been a knee-jerk reaction to so many things post-Shipman. If it’s analysed properly then there could be some benefit. But I would fear that would not be the case and the wrong conclusion would be drawn.”