The Scottish Exhibition and Conference Centre is currently alive with the sound of thousands of GPs discussing ‘Excellence in Practice.’

But just what is a working definition of excellence? The Right Hon Mike O’Brien, Minister of State for Health, made a rather brave speech. He seemed likeable and pleasant, and able to tell mildly risque jokes about bishops, which made his frequently contradictory references to “evidence” slightly disappointing.

He kept talking about excellence , nodding occasionally to the need for evidence in organising healthcare, but seemed to forget all about evidence when it suited New Labours’ focus-group-led health policies.

For example, the use of online ratings devices for GPs, he said, helped patient choice. But there is no evidence that they are reliable enough to do so, and may in fact be worse than the usual face-to-face ways people get information.

Removing practice boundaries was good for patient choice too, he said, but the harmful effect of this on such things as trying to provide good palliative care, for example, had not been even vaguely thought out.

And then there were the plans for more surgeries at weekends and evenings - which he wanted in “every single” practice, despite that fact that most users of primary care are satisfied with access (as shown repeatedly by ignored surveys). Nor is there evidence that this change in policy will be cost effective.

Then there were the usual ideas for more “preventative” check-ups, despite the fact that the majority are ineffective. 

Oh, and there was much self-appreciation for the now one-week wait for suspected cancer referrals, which is not only non-evidence based but may actually be harmful. We know from studies that it remains difficult to accurately identify suspected cases of cancer using tools available in primary care alone. Timely investigations for all may actually end up being more useful. It was all slightly uncomfortable.

Then there was the session on screening, which launched the new Sense about Science booklet: Making sense of screening. The discussion afterwards was hugely interesting - just how, in the ten minutes GPs typically have, do you give people fair and useful information about the pros and cons of screening? To me, “excellence” is in the attempt to do this - but of course you can only do it if you acknowledge there are difficulties with screening in the first place. 

The Government makes it near impossible to get fair information about most national screening programmes, never mind to opt out -  we rebels are not competent adults but ”defaulters”. This doesn’t seem to square up with patient choice, autonomy or even very ethical practice. Whereas, from  discussion at the conference, it seems GPs are way ahead in terms of knowledge of the dilemmas and issues poorly thought through screening can cause.

November 6, 2009 10:06am in Effectiveness, Medical Screening, NHS, Policy | Comment