How do GPs use patient feedback left on the NHS Choices website in their quality improvement activity? Ben Braithwaite GP London-UK MSc Health Informatics

QOF Surveys Prescribing Referrals Cancer MSF Audit Complaints

How NHS Choices feedback is used “So, immediately they’re posted I get notification of them, the next morning I’ll see them and distribute them around the group. I will discuss the merits or whatever of whatever’s on there and respond accordingly. So then I will, within 72 hours, post a response.” “I kept a copy [of an NHS Choices comment] in the same way as I would any other complaint.” “We celebrate our success by [deputy manager] promoting it at the practice meetings, so we say, Doctor so-and-so got this compliment and we read out the letter.” “We say actually you can put it on our website if you want to, but they never bother. So much so that we have a form that they can put the details down and we can put it in for them, or we give them a few details on how to do it.” “I think I try to deal with that in a PR point of view, because I see that it’s going to be seen by everybody.”

10 “[A patient wrote] I went to see a doctor at the practice, who basically said, you’re fat, it’s your fault you’re diabetic, get on with it. Now, you would have thought, […] that this was some sort of sour grapes, that they [the patient] wanted a certificate or didn’t get what they wanted… until I showed this comment as part of all the staff looking through, and immediately from the non-clinical staff got, well, we know who that is, don’t we? All of them instantly knew which doctor it was. Because he has a habit of going round, he has a thing with obese people anyway…” “Patients were finding it difficult, it was a combination of not just NHS Choices, the patient survey and our patient participation group, so we have those three things, so to speak [...] and one of the comments was, we can’t get through on the telephone.”

11 Perceived selection bias “I don’t think it reflects what anyone thinks about any practice, I don’t think it reflects what people think. It just reflects those people determined enough to make a complaint. […] I mean it’s human nature, I don’t go up to the staff in Marks and Spencer’s and say, thank you you were wonderful today. But if they’re not I will go up and say something.”

12 Anonymity/pseudonymity “These people who are not, who are not prepared to put a name to the complaint, or address it with a specific person […]I think it’s in some ways rather cowardly to put it on the website.” “Because we weren’t able to investigate properly and respond to the person properly, it may have changed their perception had we been able to investigate properly. […] It meant that we weren’t able to investigate, put right any shortcomings, or respond, or explain.” “We think we identified the patient who made the comment, you know, because obviously doctors get to know their patients quite well, and it was as we thought initially, it was probably a foreign patient, someone who was used to healthcare in a different country, not understanding the way the NHS works.”

Conclusions Online patient feedback is an important new source of data for quality improvement in primary care Needs to be treated in a different way to other patient-level data Practical and emotional barriers to using online feedback