The application by Wandsworth’s GPs for Pathfinder status was approved on Wednesday.

Essentially it makes Wandsworth one of the country’s early adopters in the move towards GP commissioning; with the GPs (working as a single Wandsworth consortia) starting to shadow the Primary Care Trust from April in preparation for taking on full commissioning responsibilities from 2013.

Wandsworth is making good progress on the health reforms. I’ve often joked that the council has long-held imperialist ambitions for the NHS in Wandsworth, but there are massive benefits from closer co-ordination between the council and health service. While GPs are the best place for commissioning, since they are the ones who are closest to the patients using the services, there are lots of benefits from closer integration with the council.

Some will be fairly obvious to residents, for example those who use both council and health services and will benefit from a better joining-up between the two. Some will be less obvious and behind the scenes, like any benefits that derive from the council’s expertise in procurement.

But I think the most beneficial will be the tighter integration of proactive and reactive services. At the risk of being overly simplistic, the health service and GPs tend to be reactive: you get ill, they cure you. Whereas the council has responsibility for many services that can have a preventative element: education is the biggest factor, but you can include things like our leisure facilities or environmental health and even go as far as including the council’s role in economic development.

This is all in the future, we’ve spent a lot of time, and will spent a lot more time, working out exactly how it will all look in 2013. But congratulations are due to the GPs, because it’s now one step closer.

View Wandsworth GP ‘approval’ ratings in a larger map
Given that the police aren’t too keen on the whole mapping thing I’m turning my attention to the NHS this week.

This map is a (not very good) attempt at showing which GP practices have the highest ‘approval’ in the borough. I did it largely to see if there was any geographic patterns, and there don’t seem to be any, so a bit of a waste of time. Basically the darker the blue the higher the approval. If there’s any pattern at all probably that there’s a correlation between deprivation and what people think of their GP, but not much of one.

The data are from the GP patient satisfaction survey, and use the most recent results. My interpretation of approval is to basically subtract the percentage of people expressing dissatisfaction from the percentage of people expressing satisfaction. (I’m fully aware that satisfaction if you measured satisfaction with me in the same way it would be much lower.) This also has the effect of increasing the margin of error, but since the results are in line with individual satisfaction and dissatisfaction ratings, as well as the results for a separate question on whether patients would recommend their surgery to others, I’m comfortable that the results have enough validity for a blog post.

It’s worth pointing that that these are based on subjective patient opinion, not on clinical outcomes. It’s entirely possible that some of those negatives will reflect decisions that, while made in the best interests of the patient, were not what the patient actually wanted.

The sample are, to a degree, self-selecting, because they are among the third or so who bothered to reply. And you might also question whether some of the higher scores are just because dissatisfied patients have left!

But I think there is some value in the data. You do not, generally, need to be a clinician to instinctively know if you are getting good care. And while I know, politically, saying anything that makes it seems like advocating a market within the NHS can be dangerous, I have to wonder why patients from Balham Hill (52% approval) aren’t all wandering down to Balham Park (97% approval). If anything it’s an argument that this sort of data should be more public, along with information on how to move. Without making any judgement on the individual surgeries or GPs scores, you would think that when it comes to health people should be looking to be satisfied rather than staying put with a GP practice with which they are unhappy.

One of the interesting factors that I think might be at play is that those practices that seem to be scoring really highly also tend to be those that have active and involved patient involvement groups. That’s certainly the case for Balham Park, which didn’t have anyone dissatisfied and has 99% of respondents saying they would recommend the practice (Balham Hill has only get 54%, 31% say they would not recommend it). While there might be cause and effect there, I’ve no idea which way round it goes – is there a patient group because it’s a good surgery, or a is it a good surgery in part because there’s a patient group.

I post it for interest. It’s well worth taking a look the full data on the GP patient survey website. And in the interests of openness, you can download the data I used for the map (essentially the Wandsworth data with a few sums and geographical data added in CSV format).