An issue of choice.

The problem seems to be one of Choice. Is there a significant choice? And a lack of choice can make people unhappy.

Government has taken this to heart, and their reforms in the NHS have latterly focussed on choice as their way to improve health.

Now to exercise choice, you need to have at least 2 options. You also need to work out what criteria you want to base this choice on, and how this can result in the desired outcome. If the choice is, how do I choose a doctor for me and my family, then the choice can be made in many ways.

Option number 1: Geographical. In my experience, the initial choice by people is simply based on which practice is closest. If you are poor (so you have to walk), or disabled then proximity is essential. So having a practice close to you is pretty important. Many people regard this as their number one criterion. Others may have only one practice to choose from, or only one hospital in realistic reach.

Option number 2: Recommendation. This is the second most common reason for somebody choosing a doctor - either family, or friends, or neighbours will all be very happy to give you their opinion. They will go on their own personal experience (which is a good thing, although hardly comprehensive). It is a better marker, however, because it is likely to have more validity.

Option number 3: Size. Some people prefer a small practice, with one or two doctors. Continuity is extremely good, but there are down sides as well: others prefer a larger practice with a greater choice of doctors.

Option number 4: Teaching. Teaching practices have been assessed for quality of patient care and quality of teaching. If your practice is a teaching practice (undergraduate or postgraduate) then this is likely to be a good marker.

Option number 5: Qualifications. The sheer number of qualifications that doctors have are a joy to behold. The Jobbing Doctor can actually put 27 letters after his name! Is MB better than MD? Is FRSM better than FRCGP? Is MRCS better than MMedSc? [The answer is no]. The one quality qualification is MRCGP. Only about 40% of GPs have this, although it is now compulsory for all new entrants in General Practice. Some of the best doctors I know have only the basic qualifications.

Option number 6: Quality and Outcome Framework Data (QoF). This is a performance linked measure that allows you to rank practices according to certain clinical and organisational markers. It was introduced in 2004, and is only of limited merit. It is probably impossible to reach the maximum score without skewing your clinical practice significantly, and some practices have reached much higher scores than they deserve. It also depends on the patient population served, so deprivation and high patient throughput militates against higher scores.

However, it does home some crude merit (the practice we took over was poor on its QoF data).

Option Number 7: Personal characteristics of the doctor. Is a younger doctor better than an older doctor? Is a foreign-trained doctor worse than a UK trained doctor? Is a female doctor better than a male doctor? Is a polite doctor better than a grumpy doctor? Possibly. Possibly not. One of the rudest (and worst) doctors I knew was a UK-trained female consultant.

Option Number 8: Premises and facilities. Certainly, better facilities can help. In house physiotherapy and counselling is a good thing. As are blood taking facilities to prevent people having to go to hospitals for this. But does a good looking building mean a good-looking service or good-looking doctors? It isn't as simple as that. Will polyclinics be a good thing?

So there you have it. A difficult problem. What is the solution? I really don't know. Some idiot in the Department of Health will bring out a website like ratemygp.co.org or ismydoctorcrap.com - and think it is a good idea. 

I wouldn't put it past them.