My first CASA working paper is now available. It is the result of a large amount of work I did for my upgrade from MPhil to PhD study at UCL. The topic is “Choice and the Composition of General Practice Patient Registers“. The abstract is as follows:

Choice of general practice (GP) in the National Health Service (NHS), the UKs universal healthcare service, is a core element in the current trajectory of NHS policy. This paper uses an accessibilitybased approach to investigate the pattern of patient choice that exists for GPs in the London Borough of Southwark. Using a spatial model of GP accessibility it is shown that particular population groups make non-accessibility based decisions when choosing a GP. These patterns are assessed by considering differences in the composition of GP patient registers between the current patient register, and a modelled patient register configured for optimal access to GPs. The patient population is classified in two ways for the purpose of this analysis: by geodemographic group, and by ethnicity. The paper considers choice in healthcare for intra-urban areas, focusing on the role of accessibility and equity.

The paper is accessible here.

Curiously, about a week after I posted on the limitations of the GP choice element of NHS Choices, the services has been upgraded. Today users were met with the following box:

This is clearly a step forward in that it allows a basic, albeit subjective, assessment of quality for patients. It remains to be seen whether the uptake of ratings will be as successful as they have been for hospitals. Bear in mind that there are roughly 10158 GP surgeries in the UK, clearly a large number of reviews are needed for it to be a viable resource.

Coupled with this, the presentation of search results for GPs has taken a step forward. As the next image demonstrates:

The new layout of search results for GPs brings NHS choices much more in line with its Hospital search. It is notable that NHS choices is now pushing the choices that people can make regarding the type of GP they want to use. The tick boxes at the top allows for a number of options geared towards choice of GP including available clinics and surgery accessibility requirements, as well as opening times. Further the initial dialogue in each returned search result offers more, by way of number and sex of doctors, languages spoken, and the potential for patient reviews. The other import from the hospitals search functionality is the ability to shortlist and compare services.

What hasn’t changed however are the methods of ordering GPs, this is still fundamentally a distance based list, although it is now more modifiable. The only other option is to list GPs alphabetically, because you might want to use a GP whose name is higher in the alphabet?! Coupled with this, there are still overtones of locality and community in the way services are distributed, as well as references to defacto catchment areas. Getting more information is also tricky, I decided to learn more about the “number of GPs” from the link on the right hand side and was confronted with the following information:

This does not actually tell me anything that I didn’t already know from the presence of the fact itself. In fact it seems markedly rushed and incomplete. Unfortunately, it would seem that beyond this new shiny facade, much of the information hasn’t changed. I still can’t find out anything new when I drill down, it is simply that the frontend has been improved. The sections that hint at GP quality are still absent or not very useful, and there are links to the NHS Information Centre for Quality and Outcomes Framework (QoF) data which is at best confusing and intimidating.

Nevertheless, I may revisit the patient reviews as a data source in the future and investigate how good a source of data they may be. They may add value to a mash-up of primary care services, or contribute to a discussion of neo-geography.

I am growing very interested in how the NHS actually facilitate choice within the primary care system. This post investigates the apparent asymmetry between choosing a hospital and choosing a GP using NHS Choices, the NHS’s online health portal. Figure 1 is a screen capture of the results list presented when searching for a GP, figure 2 is the equivalent results for a hospital search.

The GP search creates a basic proximity ranking of the potential GPs available from an individual’s postcode, as per the example of a GP search shown in Figure 1. Search results cannot be manipulated in any other ways, meaning that non-accessibility based criteria which prospective patients might wish to fulfil cannot be met. Options related to choice are not-present at the start (these could include patient list size, number of doctors, services offered etc), although some of this information is available when you ‘drill-down’ by selecting a specific GP.

When searching for hospitals it is possible to search not only by postcode but also by specialty. When search results are presented they are given with an indicator of “Quality of Service” from the NHS Annual Health Check, which measures Hospital performance. Further, the results also include the standardised mortality ratio, and some wiki-style reviews of the hospital. All this information exists for Hospitals without drilling down, and when you do there are further measures to help patients choose a suitable hospital.

GPs, unlike hospitals, have very limited quality criteria confined to opening and closing times. The NHS seems to limit the possibility of defining a GP as good or bad through use of waiting times, understandable prevalence data and such. This attitude in particular seems contra to the choice agenda being pushed. However GPs (surgeries) are a partnership between the public NHS trust and the private General Practioner(s) (GPs – doctors) that run them so such a black and white classification may be difficult for the NHS to achieve politically, despite the likely patient benefit.

Figure 1: NHS Choices, GP search results for a postcode in North London (http://www.nhs.uk)

Figure 2: NHS Choices, Hospital search results for a postcode in North London (http://www.nhs.uk)