To improve healthcare, the effectiveness of services must be measured. But it must be done carefully, addressing issues that matter, in a way that provides an accurate reflection of the quality of care provided.
This is tricky to achieve in any sector and particularly in healthcare, where a patient's agenda may differ from that of a health professional or the NHS; emotions run high; and poor service really can mean the difference between life and death.
So it comes as a surprise that ministers feel the best way of evaluating GP practices is to rate them 'out of 10' in the manner of Tripadvisor, a travel website that compiles star ratings of venues and restaurants.
What is vital to measure in general practice is surely accuracy of diagnosis and use of appropriate, evidence-based prescribing and referral. However, surgeries are to be rated on opening hours; ease of getting an appointment; time spent waiting in reception; and whether or not health professionals listen. An overall rating for each surgery will be published online by NHS Choices.
Ministers claim this will 'make it easier for patients to find the best NHS care for them', enabling people to find surgeries with experience of treating particular conditions. The BMA describes the system as a 'blunt instrument', warning it fails to take account of challenges faced by individual practices. The criticisms are manifold: the scoring system is simplistic, preventing patients from giving detail; ratings can be highly subjective; and people with grievances are more likely to respond than those happy with their practice. Moving surgery may be tricky if there are few local practices and the good ones are all over-subscribed.
Despite this, the system has been put in place 'with immediate effect', proving that ministers are better at asking other professionals to listen to feedback, than they are at listening themselves.
Sarah Wild, editor, Independent Nurse