General practice remains under significant and growing pressure. According to the King’s Fund workload is not only rising but also becoming “more complex and intense” with funding lagging behind demand and GP numbers still falling.
The only answer appears to be for practices to become more productive and to work differently. However, there is no standard tool – or set of them – that can effectively show individual practices how to be more productive or the different ways in which they can work to survive and thrive.
Based on these circumstances and after consulting GPs, practice staff and the public, the King’s Fund developed and tested an effectiveness measure – the general practice effectiveness tool (GPET). For anyone with experience of working in general practice, the study findings reveal no shocks or surprises.
A total of 51 practices trained to use the GPET which covered 4 performance areas (clinical care, practice management, patient focus and external focus) data for which are routinely collected by practices.
38 of them used the tool longer than a couple of months and noticed moderate improvements in practice management and patient focus.
The GPET model was designed using workshop feedback and practices found it appropriate and comprehensive because it included the measurement of items not currently within QOF.
However, problems arose around measuring data from indicators derived from practice records which would not have been collected or stored in a uniform way because there is currently no system, standard or requirement for collection, submission or central/local NHS reporting of these data.
The authors, Jeremy Dawson and Anna Rigby-Brown, reported considerable variation in how much practices said they would use the tool, how useful they found it and how easy it would be to use. Responses ranged from enthusiasm and positivity to no obvious benefit in general or in relation to the time investment required.
This study set out to create a tool to measure productivity or ‘output’ (quality and activity) against ‘input’ (expenditure and resource use) and so provide a method for any general practice to quantify its effectiveness in a standardised way to shine a light on where to improve productivity and how to work differently.
However, as it turned out, this was systematically unachievable due to the methods used by this pilot study in light of the uniqueness of individual practices, together with the significant variation of results from standard measurement of non-mandatory data reporting or collection.
This appears to have been a useful study. The findings seem to indicate that, with refinement, selective standardisation and some updating around SNOMED, GPET may yet provide practices with a tool to identify how to optimise productivity, improve efficiency and inform – what will inevitably be individual – practice sustainability plans.