Why numbers matter in general practice

Helen Salisbury, GP, discusses the importance of measuring and counting – and why an absence of this is harmful

CREDIT: This is an edited version of an article that originally appeared on The BMJ

Medicine involves lots of measuring and counting. We weigh babies to check that they’re thriving (and especially when we’re worried that they’re not). We monitor blood pressure, blood sugar, cholesterol and kidney function. At practice level we measure the proportion of our patients who have had their cervical smears done, or been given advice about smoking, and we’re incentivised to do this through the Quality and Outcomes Framework (QOF).

Measuring is rarely neutral. It focuses attention and, even with no other specific intervention, can bring change. This monitoring effect is the reason some people will improve their fitness when they use an exercise tracker, or will lose weight after logging what they eat. For both the individual patient and medical organisations, we’re often chasing targets, getting a blood parameter to below X or waiting times down to Y. Over the years there have been many debates about QOF, and advocates for patients with illnesses that don’t feature in the framework have highlighted that doctors’ attention and efforts may be skewed instead towards those areas that are rewarded.

At a fundamental level, it’s impossible to count or measure every ingredient of high-quality general practice. What my patients may need most is my quiet attention while they struggle to express their grief, their pain, or the fear sparked by an innocuous symptom and an online search. The ability to reassure is dependent on trust, and may rely on a relationship built over many consultations—something not caught by any metric. There’s no tick box to say, ‘Patient reassured; no investigations necessary’ although this is, arguably, one of the biggest contributions GPs make to the efficiency of the NHS.

Just as measuring something can highlight its importance, failure to do so can suggest the opposite and ceasing to measure something that used to be regularly monitored and reported sends a strong message…