Top priority - health watchdog targets Skegness practice

The Beacon Medical Practice in Slegness. EMN-141125-150205001
The Beacon Medical Practice in Slegness. EMN-141125-150205001
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A health watchdog has listed a general practice in Skegness as a top priority for inspection due to evidence of ‘elevated risks’.

The Care Quality Commission (CQC) has, for the first time, analysed and published data on every practice in England to show the public how it will decide which surgeries it will inspect and on what issues it will focus.

Under the so-called ‘Intelligent Monitoring’ system, each practice is placed into one of six priority bands.

Last week, it saw Beacon Medical Practice, in Churchill Road, Skegness, being awarded a Band One rating - representing the highest priority.

It came in light of three ‘elevated risks’ and seven ‘risks’ from a total of 38 indicators.

‘Elevated risks’ included the percentage of patients aged 65 and older who have received a seasonal flu vaccine (58 per cent compared to an expected 73 per cent) and the percentage of dementia patients who have been reviewed face-to-face in the past 12 months (54 per cent rather than the expected 84 per cent).

Prof Steve Field, chief inspector of general practice, said: “It is important to remember that the data is not a judgment as it is only when we inspect we can determine if a practice provides safe, high-quality and compassionate care.

“The data is a further tool that will help us to decide where to inspect and when.”

A spokesman for Beacon Medical Practice said: “The practice does its best for all of its patients, and fully supports the need for patients to have accurate information on its performance, but it is disappointed the method used by CQC is very debatable and does not take into account the special circumstances and problems the practice has, which are well documented.”

These included, it says, the pressure caused by holidaymakers and temporary residents on caravan sites and high number of elderly and infirm patients in the area.

Elsewhere, Hawthorn Medical Practice, in Hawthorn Road, was given a Band Four rating, in light of evidence of three ‘risks’, while Wainfleet Surgery, in Wainfleet, was given a Band Six rating, with evidence of one ‘risk’.

Spokesmen for the practices said they would be considereing the CQC’s findings before commenting publicly.

Dr Brynnen Massey, chairman of the Lincolnshire East Clinical Commissiong Group, said: “The CQC’s Intelligent Monitoring reports use data for GP practices from a range of sources relating to important areas of care, which give the CQC a clearer understanding of each practice and help it to decide when, where and what to inspect. The reports include indicators covering a range of activity in practices and the experiences of patients, and are not a judgment on GPs.”

Find the report here.

Full statement from Beacon Medical Practice ...

“The practice does its best for all of its patients and fully supports the need for patients to have accurate information on its performance, but it is disappointed the method used by CQC is very debatable and does not take into account the special circumstances and problems the practice has, which are well documented.

“These include the pressure caused by having to treat an ever increasing number of holidaymakers/temporary residents on caravan sites which is not properly funded, the inability of the NHS to do anything to help improve the surgery building in Chapel St Leonards, which is designated not fit for purpose and too small, the problem recruiting doctors in the area, deprivation and the significant high number of elderly/infirm patients which also has an effect on the amount of drugs needed by our patients, referred to as a ‘risk’ in the report.

“It is significant Marisco surgery in Mablethorpe, the other main holiday practice, has been given the same rating.

“We are also concerned that things outside the control of the practice are used to identify a ‘risk rating’ e.g. flu vaccinations. Patients and the practice’s Patient Participation Group (PPG) have praised the way our flu clinics were operated, but we are quoted in this field as being an ‘elevated risk’ and later a ‘risk’ because more people don’t want a vaccination. We did advertise and strongly support the scheme, as did the PPG, but we feel Government and the NHS could also have done much more to encourage people to get vaccinated.

“There are also ‘survey’ issues that we feel were not properly taken into account, and these kind of ‘snapshots’ rushed out as they are, can be very misleading and disturbing.

“The chairman of the PPG, who has substantial experience in this type of thing, is equally concerned and he has written directly to the CQC, significantly picking up the type of factors we also identified. Below are the relevant bits from his e-mail:

“For initial clarification I wish to state I am all for accurate patient information and proper measurement of the performance of GP practices.

“I am however extremely concerned about the way the GP ‘Intelligence Monitoring’ has been done, and the impact it can have on both patients and practices, capable as it is of giving both false reassurance and conversely lead to unwarranted criticism.

“To quote a well-known saying ‘there are lies, damned lies and statistics’ and to be meaningful surveys and comparisons such as this have to be comprehensive accurate and useful. Sound bites, frankly, are not good enough and becoming all too common.

“I have carried out limited and random checks and also studied the questions which indicate ‘risk’ and ‘elevated risk’ and make the following observations as examples of my concern. There are many more

“How do you relate to the fact that no matter how hard practices may try, and how successful their flu clinics are, you cannot force people to have a jab, yet it can show as an adverse factor which is shown, or at least perceived to be a failure of them? Government did not do enough advertising of the service either.

“I am not sure how you relate as a preventable risk such things as the issues relating to ambulatory care? Could you enlighten me please. Clearly different areas have different demographics and age profiles and this can also relate to the type/number of drugs prescribed which is used as a parameter. Hardly a “risk” if the drugs are necessary.

“My major concern however relates to the use of ‘patient surveys’ – something I am well versed in. I have been unable in relation to many practices to ascertain as a member of the public if a proper patient survey has been undertaken during the time period. Certainly they are not on the website. Should they be? Can you advise me that you ascertained they all had one within the valid timescale bearing in mind they play such a major part in the results?

“Many have results from a very small base, considerably less than even five per cent of the practice total in many cases, even though efforts were made for a higher figure. Hardly a sound base for your conclusions but no indicative figure of the percentage from which the results were taken is shown or noted as a considerable variable.

“I would suggest that in itself is the biggest risk in relation to your findings. It is also a fact people are more inclined to fill in a survey if they have ‘an axe to grind’ and people who are generally satisfied don’t bother. In short, surely you should not use figures that are below a set percentage determined for reasonable accuracy and fairness? Otherwise the figures are not really meaningful.

“In some small areas/practices there can be just one or two doctors – that makes a nonsense of figures relating to seeing the same doctor or doctor they prefer to see? There is also the question of specific skills of particular doctors in a practice.

“No effort has been made to categorise the relevant seriousness of each indicator – surely another key parameter missed as they do not carry the same weight.

“I could go on, but I hope I have clearly outlined my legitimate concerns, but I wish to be fair and would welcome an early response from you...

“For transparency I am chairman of a PPG that has been rated one – but I would have voiced these concerns regardless of its position, and I am not in any way acting on behalf of, or even with the knowledge of, the practice or the PPG. I am acting as a concerned citizen, but I will however copy them into my e-mail and any reply I receive. My concern is the increasing use of often misleading and/or meaningless statistics, particularly if their basis is not sound and proven. I campaigned on a similar basis on such things as ‘crime statistics’ relating to police forces, now found to be correct, and have reservations about releasing ‘death rates’ of surgeons which could lead to ‘cherry picking’ to the detriment of seriously ill patients.