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Wednesday 28 September 2016
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Insight: In the Loop

Insight: In the Loop

Communicating effectively with patients about results and data relating to performance can help reduce misunderstanding and dissatisfaction

More and more often, general practice is in the public gaze. It is right that any wrongdoing is brought to light and dealt with appropriately, but the reporting of practice performance in newspapers or the internet - while making less sensational reading - can have severe and long-lasting consequences for the practice concerned.  

General practice exposed

There are a variety of issues that make general practice newsworthy – so let’s take a look at some of these potential minefields.

Performance statistics 

These may be useful in-house measures but once in the public domain the same figures can cause havoc. Think, for example, about what happens when the quality and outcomes framework (QOF) results are published – great news  if you happen to have ‘full marks,’ but what about the practices that have not quite made it? How easy is it to explain ratings to patients? Or to make clear the blood, sweat and tears that have gone into achieving the points the practice has earned. I bet I am not the only manager to have received letters from patients informing me of their intention to move to the ‘better’ practice up the road.

Reports 

You might imagine that a structured, evidenced report from a recognised body would give the reader a more balanced overview. Take for instance, the Care Quality Commission (CQC) inspection report for health service providers. Every registered provider, which includes GP practices, has a profile page on the CQC website. During an inspection judgements are made on 16 separate standards such as providing care, treatment and support, quality of management. The practice is invited to comment on the report prior to it being published but has no voice thereafter. The report is then added to the provider’s profile in a summarised format using a series of ticks and crosses with the full report available as a PDF file. While some patients will take time to read the entire document, it is highly likely that many more will only look at the summary, make assumptions and, worryingly, take their custom elsewhere.  

Safeguarding patient data

Recent events regarding Care.Data, the patient data sharing scheme, has brought the security of patient information right back into the spotlight. Revelations that patient data, including age, diagnoses, and waiting times had been available online has done much to undermine public confidence in the ability of the NHS to protect information. The fact that this was secondary care data will not stop our practice populations from eyeing us, and the General Practice Extraction Service (GPES), suspiciously too. Once again (remember the outcry when the summary care record was first introduced in England?) we will have to demonstrate our competence in protecting this privileged information in order to uphold that keystone of the patient/ doctor relationship – confidentiality.  

Social media 

Patients do not have to think twice before making their opinion of the local practice a public statement on sites such Twitter. How to respond to such (often adverse) comments on social media is a growing concern for many practices. The desire to defend the practice’s reputation is completely understandably but is best resisted if the practice wants to remain on the right side of British Medical Association (BMA) guidance.  

Letting the patients know

How much better would it be if we just grasped the nettle at the outset, explained to patients why points,  scores, systems are the way they are and asked what people they thought, how we could do better? We can be our own worst enemies when it comes to working with patients. We do not always explain systems and processes well enough, we are guilty of trotting out sentences that are full of jargon and acronyms – T/Res, INR - and often make decision for patients, eg. setting up systems where opt in is the default because we feel this is in the patient’s best interests. All of which can make patients anxious and annoyed. 

So, how to manage this? In exactly the same way as you would deal with any other difficult conversations - professionally, calmly and with plenty of preparation. Below are a few idea you might consider trying.  

Patient groups 

Are you participating in the patient participation group directed enhanced services (DES)? If so, what better place to start than with this ready made audience? An offline conversation with some reasonable or sympathetic members prior to the meeting explaining upcoming inspection reports, outcome measures might allow you greater support on the day. Perhaps a short presentation on the practice’s information technology (IT) and the security systems it has in place could go a long way to allaying patient concerns re confidentiality.

Public meetings

I did say grasp the nettle but there is a happy medium – and if the topic is emotive, you could invite along an impartial chair, such as a patient involvement worker. A meeting to support an application for new practice premises is one thing, but a discussion around reported poor standards is an altogether different evening. Nonetheless being pre-emptive is always a good idea as it is much easier to say “please help - we have a problem” than to have to explain “well, we didn’t want to worry anyone, but…” 

Social media

Make use of the practice website, blog, Facebook page or Twitter account. It is perfectly acceptable to use social media to your advantage such as to inform your patients.

Noticeboards and leaflets

Old technology still has its place. A paper flyer or notice about patient data or QOF results is preferable to saying nothing.  

A better balance

Surely it is better to be upfront, discussing hard truths with patients and gaining their support and understanding. Working together is not just important, it is vital. In this way issues can be addressed and the threat to reputation and income minimised.  

However, it should be remembered that a poorly performing practice can have significant implications for patient care and so measures, inspections, reports and public accountability are essential too. We are ALL safer as a result.