Public opinion

10 December 2012
Volume 28 · Issue 11

Eddie Crouch explores the problems of the NHS Choices website.

The NHS Choices website was launched in 2007. In November 2010 it launched a service supposedly allowing practices to edit their own key information, such as opening times and acceptance policy of new patients. The ability to do this editing was conferred by the PCTs but few managed the difficult task of giving these editing rights to practices, and currently in my cluster some two years on no practices can do this.

As a member of GDPC Executive I had the ‘pleasure’ at that time of meeting representatives of Capita, the company employed by the Department of Health to manage the website. It was perhaps a sign of getting old but I felt uneasy on many levels about an attempt to create a ‘trip advisor’ site for NHS dentistry. Many of the concerns we raised then, regarding malicious anonymous postings being potentially commercially damaging, were down played as something that would not happen as the site was well moderated. Don’t you hate it when someone says I told you so?

A total of nearly 9,000 postings have been made about dental practices according to an FOI answer in early September of this year. Some 3,000 practices have been reviewed, and 490 such postings have been rejected by the moderator (presumably due to abusive or foul language).

Of course when a posting is made about a practice that is critical in any manner, the PCT is notified. Recently a colleague contacted me about an alert from his PCT that happened within a few minutes of a patient posting something about his practice. Having read the posting he knew immediately it could not have been his practice. Indeed NHS Choices agreed that the posting was placed against the wrong practice and removed it. Sadly however it’s not always that obvious and I wonder how many other postings are similarly inaccurate.

It is relatively easy to post comments on the site. No checks are made when you register and you can use any created email address with no name or address needed to say what you like (within reason) and it’s not difficult to create a commercial weapon against a competitor’s practice without any recourse at all.

Another example highlighted to me was one where the ‘patient’ mentioned a failing distal occlusal amalgam with a fractured distal box. Clearly this poster was someone with dental knowledge or heaven forbid potentially a dentist out to besmirch a colleague. This complaint against the practice resulted in a solicitor acting on behalf of the practice, demanding the posting was removed.

Such demands are referred to the NHS Choices User Council. It failed to spot the language used in the posting and said it was a perfectly legitimate posting to have against the practice.

As practices we all have complaints procedures and dealing with complaints is a method of changing protocols and improving patient care .However NHS Choices regularly provides no such learning, as often the poster is anonymous and clearly the chances of it being malicious, even not your practice, are high.

However, that’s not the end of it, the CQC has stated it is planning to review the comments that the public submit on NHS Choices about dental practices, to support its monitoring of compliance with essential standards of safety and quality.

They will use comments as one of a number of sources to inform where risks lie, and prompt regulatory activity such as an inspection. So, perhaps it is not as innocuous as it seems, and certainly not to be ignored. The website says you can respond to the criticism on the site and perhaps encourage happy patients to post thus diluting the negative criticism. A recent letter in the BDJ, from someone I had the privilege of training with at dental school and an excellent clinician, shows how even these actions are flagged up. In response to an unjustified vindictive comment, he encouraged all his happy patients to tell everyone on the Choices website what a good dentist he really was. He was contacted by his PCT because he was an outlier in high volume of positive comments. He was notified that whilst his vindictive poster could remain, some of the positive ones would have to go. So why is the website given the credibility it hardly deserves?

As recently as May this year, the Office of Fair Trading report into NHS dentistry recommended a call for greater public awareness of the NHS Choices website. I also understand there is consideration of promoting the site on the NHS charges poster we are contractually obliged to display.

Being presumptuous is obviously in the OFT remit and it suggested DQOF data should be posted on the website in the future. There was me believing that pilots were testing DQOF, but the OFT seem to know the future ahead of any evaluation of the current dental pilots.

The OFT continued by suggesting BSA data on practices from patient surveys, sent out from Eastbourne, are also published on practice pages so patients can make informed decisions on where they wish to access their NHS care. Of course patients are always so reliable when they fill in such surveys that include questions like, “Did you see any information about patient charges for NHS Dentistry at the surgery?”

The new health service will remunerate providers on Patient Reported Outcome Measures (PROMS) so can we look forward to clawback based on the negative comments on a website that allows anonymous postings?

Whilst it is unrealistic to expect this site will not be part of our futures, the GDPC will continue to argue that comments should be attributable and that allegations of malpractice and misconduct or potential fraud should be referred to the practice or local area team, not on public display without ratification or evidence. The GDPC argues for these improvements whilst continuing to point out the nefarious effects that are fundamentally related to the process as a whole. The topic of NHS Choices featured at the last meeting of GDPC and no doubt will stay high on the agenda, for even if the new NHS structure change the name of this website, it’s not going away.