General practices could be subject to “Ofsted style” ratings within two years

BMJ 2013; 346 doi: (Published 22 March 2013) Cite this as: BMJ 2013;346:f1941
  1. Gareth Iacobucci
  1. 1BMJ

A new rating system to assess NHS services in England, akin to the school rating system used by Ofsted, the official body that inspects schools, could be rolled out to general practices in less than two years. However, it may need a longer development period before being extended to hospitals, experts have concluded.

Last year the health secretary, Jeremy Hunt, commissioned the health policy think tank the Nuffield Trust to conduct an independent review to assess the feasibility of proposals to reintroduce a simple ratings system for NHS services.1 The review identified a “clear gap” in the availability of information to patients that could properly inform them about the quality of care and improve the accountability of providers.

But it said that ministers should ensure that a range of measures were taken before they pressed ahead with plans, including assessing how and when services could adopt the new system and evaluating the costs and benefits of the plans from the start.

Jennifer Dixon, the Nuffield Trust’s chief executive, who led the review, said that a new system could be applied to general practice and social care in less than two years. But she warned that the process may be less clear cut for hospitals, where the long term goal should be to rate individual departments and clinical services to produce “a much truer understanding” of the quality of care provided.

Speaking at a briefing on the report, Dixon said, “General practice . . . has made impressive headway with the indicators they have got. For hospitals it’s more complicated, but that doesn’t mean we can’t start and do something useful. A start could be made in under two years.”

Before implementing a new system, the government should assess whether the rating system would create any extra work that could detract from patient care, the report said. It added that the organisation that produces the rating—it suggests the Care Quality Commission—must be given “the resources, time to manage and develop a new strategic direction, political support, and support from other stakeholders, as well as stability from disruption over a period of time.”

It was vital, the report said, that the new rating system’s design and presentation were “sector led” and involved patients and the public. It was important that any new system linked closely with existing frameworks for measuring, investigating, and monitoring quality, it said, and that a “consensual process” was agreed to further develop the rating over 5-10 years.

Possible sources of information that the report said could contribute to the rating included Quality and Outcomes Framework (QOF) indicators in general practice, computerised hospital records, surveys of patients and staff, peer reviews and inspections, and self assessment.

In addition, it suggested carrying out further market research on how the results of such a system could be communicated to the public—particularly in cases where a limited choice of provider existed.

Dixon added, “There is a major gap in the information available to the public on the quality of care of their local hospitals, GP practices, care homes, and other providers. One aggregate, comprehensive rating of providers may provide more clarity and simplicity for the public, especially if it came from one ‘official’ trusted source.

“However, this is not a simple task, and it’s clear from the responses we received to our consultation that there is more appetite for introducing ratings in social care and possibly general practice than in hospitals, which tend to be more complex in the range of services they provide.

“Constructing a summary rating for hospitals is possible but would be a difficult and complex task. Ultimately the goal should be to introduce ratings that drill down to the level of individual departments and clinical services so that patients can have a much truer understanding of the quality of care provided in those departments.”

The government has emphasised that the new system would be distinct from the unpopular star rating system implemented by the previous Labour government, which was abolished in 2004.2

A Department of Health spokesperson said, “We know we would need to get any rating system right, but the principle that people should get clear information about quality of services has to be the right one.”

Mark Porter, the BMA’s chairman of council, said, “It is particularly welcome that the [Nuffield] Trust has taken on board concerns about ratings for entire hospitals. As the BMA and many others pointed out, hospitals are highly complex organisations, and their performance cannot be measured in any simplistic way.

“However, there are always going to be problems constructing indicators that measure quality in any meaningful way and do not result in a target driven culture.”


Cite this as: BMJ 2013;346:f1941