Intended for healthcare professionals

Primary Care

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

BMJ 2002; 325 doi: (Published 30 November 2002) Cite this as: BMJ 2002;325:1278
  1. Martin N Marshall, professor of general practice (martin.marshall{at},
  2. Julia Hiscock, senior researcherb,
  3. Bonnie Sibbald, professor of health services researcha
  1. a National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL,
  2. b National Centre for Social Research, London WC1V 0AX
  1. Correspondence to: M N Marshall
  • Accepted 27 August 2002


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 andpractice 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 practicalimplications. Attitudes were strongly influenced by experience of comparative reports from other sectors—for 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.


  • Funding This study was funded by the UK Department of Health through core support for the National Primary Care Research and Development Centre, University of Manchester. The views expressed in the paper represent those of the authors and not necessarily those of the funding body.

  • Conflict of interest None declared.

  • Embedded Image The mock report card appears on

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