Primary care

Attitudes to the public release of comparative information on the quality of general practice care: qualitative study

Martin N Marshall, professor of general practice, ^a Julia Hiscock, senior researcher, ^b Bonnie Sibbald, professor of health services research. ^a

^a National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL, ^b National Centre for Social Research, London WC1V 0AX

Correspondence to: M N Marshall martin.marshall{at}man.ac.uk

Objectives: To examine the attitudes of service users, general practitioners, and clinical governance leads based in primary care trusts to the public dissemination of comparative reports on quality of care in general practice, to guide the policy and practice of public disclosure of information in primary care.
Design: Qualitative focus group study using mock quality report cards as prompts for discussion.
Setting: 12 focus groups held in an urban area in north west England and a semirural area in the south of England.
Participants: 35 service users, 24 general practitioners, and 18 clinical governance leads.
Results: There was general support for the principle of publishing comparative information, but all three stakeholder groups expressed concerns about the practical implications. Attitudes were strongly influenced by experience of comparative reports from other sectorsfor example, school league tables. Service users distrusted what they saw as the political motivation driving the initiative, expressed a desire to "protect" their practices from political and managerial interference, and were uneasy about practices being encouraged to compete against each other. General practitioners focused on the unfairness of drawing comparisons from current data and the risks of "gaming" the results. Clinical governance leads thought that public disclosure would damage their developmental approach to implementing clinical governance. The initial negative response to the quality reports seemed to diminish on reflection.
Conclusions: Despite support for the principle of greater openness, the planned publication of information about quality of care in general practice is likely to face considerable opposition, not only from professional groups but also from the public. A greater understanding of the practical implications of public reporting is required before the potential benefits can be realised.

What is already known on this topic Disclosure of information about quality of care in the NHS has been strongly influenced by the report card movement in the United States This was based largely on hospital data, with no evidence to determine the attitudes of the British public to the publication of quality reports in general practice What this study adds The public and health professionals are in favour in principle of publishing information about quality in general practice but are concerned about the consequences for themselves, the practices, and the health system People regard public disclosure as a political initiative and are more inclined to trust their own experience or that of friends and family than to trust comparative data General practitioners perceive comparative reports as a burden, and clinical governance leads are concerned that the reports might damage their facilitative approach to improving quality