Vanguards: how will we know they are working?

Paraphrasing Alice’s Cat, “If you don’t know where you are going, any road will get you there.”  This week 29 Vanguard sites have set off with high intentions of getting somewhere near a Five Year Forward View, but where is this?

I suspect we will see broad consensus on the purpose, high quality care and so on, but the decisions on what to measure are crucial and this is where the seeds of success or failure will be sown.  The problem is that the way things are measured becomes the purpose.

This week we were told that the whole NHS has failed the four hour target for A&E for so many months.  Think about this for one moment:  the entirety of the A&E service is a failure (politically defined).  The statement is obviously ridiculous, yet no major party says so, or that the real failure is to understand demand into A&E so we can focus on the causes.

It’s not only targets which feel right but work wrong.  I’ve seen NHS organisations in all good faith make patient satisfaction the goal, and find they are chasing rainbows (the pointless FFT included).  Have you noticed that patient satisfaction, for almost everything, is 80% plus or minus 5%?

I think it’s a wonderful thing about us humans, that we are never satisfied.  There’s an arbitrary gap between what we have and what we want.  In a typical GP Access intervention, wait to see a GP drops 80%, to all the same day, patients are not turned away, and GPs feel in control again.  Yet we’ve found that on a simple satisfaction measure there’s no change between before and after.

If satisfaction is the purpose, then you can logically say there is no point trying.  If an effective and efficient health service is the goal, then we can design measures around demand, flow, outcomes and efficiency which really do matter to patients and providers.

Many stop at the point of saying “We know the right thing to measure, but it’s hard.  Let’s do something easy”.  Fine, we’ll stay stuck in the same old thinking.

Let me know what you propose as the key measures.  I’ll come back to the subject with how we can measure quickly and easily.  With minimal effort on the collection and analysis, we can concentrate on new thinking.

Harry Longman
Founder, Chief Executive
GP Access Ltd

PS we do run measures of patient satisfaction and have been surprised at what we learned, which changed our approach.  Results here.

3 responses to “Vanguards: how will we know they are working?”

  1. Ray Montague says:

    The measurement I am most interested in at the moment is the percentage of consultations delivered by the usual GP.

    On the grounds that the drive for increased immediate access Will have a detrimental effects if continuity is lost. So we need to be able to track continuity and this is a reasonable measure of that…, so obviously not perfect

  2. Phil Price says:

    It could be easy to chase cost per patient measures, but these don’t reflect quality and are too easily seduced by inappropriate intervention. The real issue around integrated community services and urgent care is down to timely management of the at risk cohorts by GPs. So we really need to measure or understand the balance of time committed in general practice to prevention of inappropriate admission and intervention on this cohort. More GP management will reduce the A&E demand and start to ease systemic pressures whilst delivering on care closer to home.

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