OK David, preparing your notes for GMSC, surely you will have to hand
some thoughts on what information _should_ be collected to indicate
areas in which assistance could be offered to improve performance.

Which ones did you have in mind?

Locally in Devon we are collecting information on Statin prescribing,
and the most likely outcome of that activity is to improve performance
by increasing it for CHD, whereas reducing it where no gain is likely
is a very much secondary activity.

One figure which one might well collect would be the stress index of
the GPs - and perhaps nurses - and the group who would be pressed to
act to reduce peaks in it would be managment rather than clinicians,
for the most part.

Theory:  Less stressed doctors perform better for their patients than
highly stressed ones.

It would be possible to measure (weigh) the admin running over our
desks, and feed back this number ...

Theory:  a HA or PCG area with a low total weight over all doctors is a
better managed one targetting its admin more accurately, saving money
and directing this to the care of patients and saving time likewise.

We could look at the time from bellyache to knife, and the time of day
of operation, in appendicitis.

Theory:  within limits a lower time is likely to indicate better
organisation of the serivces both within primary and emergency care in
the community and in specialist care and administration in the acute
sector.
Theory: operations done in working hours produce better results than
operations postponed until after routine work has been done...

We could look at certification.
Theory: treatment or investigation for new back pain should be under
way before the second certificate is issued...theory:  this makes a
return to work more likely, oh dear, I suppose that one is economic,
despite the psychological benefits of working.

We could look at visiting rate in the Co-op.
Theory: there is a correct visiting rate, and departures from it by
individuals or groups indicate that opportunities to practice the
management of uncertainty and the reduction of stress, or specific
training funded by the PCG in particular areas of medicine in which
excess visits are occurring, are likely to improve the well-being of
the doctors and (oops) save money in the Co-op.  
Theory:  visits are expensive in the care they remove from others, the
opportunity cost, and therefore reducing unnecessary ones may improve
care of other patients.

I suppose there are other things we could use as interesting
performance indicators.


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