Godden, S.

Macfarlane, A. J.

Pollock, A.

English

City Research Online

Macfarlane, A. J., Pollock, A. & Godden, S. (2012). NHS data in the time of reform: Authors’ reply to Soljak. BMJ: British Medical Journal, 344, e4141 -e4141 . doi: 10.1136/bmj.e4141 <http://dx.doi.org/10.1136/bmj.e4141>City Research OnlineOriginal citation: Macfarlane, A. J., Pollock, A. & Godden, S. (2012). NHS data in the time of reform: Authors’ reply to Soljak. BMJ: British Medical Journal, 344, e4141 -e4141 . doi: 10.1136/bmj.e4141 <http://dx.doi.org/10.1136/bmj.e4141>Permanent City Research Online URL: http://openaccess.city.ac.uk/1248/ Copyright & reuseCity  University  London has developed City  Research Online  so that  its  users  may access the research outputs of City University London's staff. Copyright © and Moral Rights for this paper are retained by the individual author(s) and/ or other copyright holders. Users may download and/ or print one  copy  of  any  article(s)  in  City  Research  Online  to  facilitate  their  private  study  or  for  non-commercial research. Users may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain. All material in City Research Online is checked for eligibility for copyright before being made available in the live archive. URLs from City Research Online may be freely distributed and linked to from other web pages. Versions of researchThe version in City Research Online may differ from the final published version. Users are advised to check the Permanent City Research Online URL above for the status of the paper.EnquiriesIf you have any enquiries about any aspect of City Research Online, or if you wish to make contact  with the author(s) of this paper, please email the team at publications@city.ac.uk.NHS DATA IN THE TIME OF REFORMAuthors’ reply to SoljakAllyson M Pollock professor1, Alison Macfarlane professor2, Sylvia Godden honorary senior researchfellow 11Centre for Primary Care and Public Health, Queen Mary, University of London, London, UK; 2School of Health Sciences, City University London,London, UKSoljak seems not to understand how the Health and Social CareAct 2012 will limit the availability of routine data to monitorthe health service and the population by abolishing area basedstructures and transferring most health service responsibilitiesto non-geographically based clinical commissioning groups.1Neighbourhood statistics and the index of multiple deprivation(IMD) increasingly draw on a range of more timely populationbased administrative and survey data,2 but even this fuller rangeof data and readily available tables to convert postcodes tooutput areas and IMD scores cannot compensate for variationin output areas and the potential for practices to cherry pick thehealthiest and wealthiest patients from more deprived outputareas.Average list inflation is not only around 5% but varies by up to30% in some primary care trusts.3 Also, in Manchester only78% of names and addresses held on general practice registerscan be matched with equivalent records held on the council taxsystem.4The developments in using data from general practice systemsare not new datasets and do not supersede data collections thathave been lost or have deteriorated after cuts to the NHS andOffice for National Statistics.General practices might provide more up to date data than thecensus, but these data will be seriously incomplete in respectof the residents living in an area. Moreover, data will berecorded only when people register and will be updated onlywhen they consult, with data missing or out of date for thosewho do not consult.The ethnicity study in Scotland is irrelevant as South Asianethnicity was identified retrospectively from surnames ratherthan being self-reported.That general practice and hospital systems all use classificationsbased on ICD-10 is no guarantee that the ICD codes will beallocated or derived in the same way.5The switch from contiguous administrative areas to a system inwhich nobody has ultimate responsibility for monitoring andmeeting the healthcare needs of all residents and in whichgeneral practices are incentivised not to take on high risk patientsmeans that those who do not receive care will no longer becounted or measured, as in low income countries.6 7Competing interests: None declared.1 Soljak M. Dismantling the signposts to public health? No, satnav has arrived. BMJ2012;344:e4137.2 Pollock A, Macfarlane A, Godden S. Dismantling the signposts to public health? NHSdata under the Health and Social Care Act 2012. BMJ 2012;344:e2364. (26 April.)3 Primary Care Commissioning. Tackling list inflation, 2012. www.pcc.nhs.uk/tackling-list-inflation.4 Getstats. Health data under threat, 2 May 2012. Response fromNeil Bendel. www.getstats.org.uk/2012/05/02/will-nhs-stats-be-less-reliable-in-future/.5 Beerstecher H. Rapid response. Primary care data: all that glitters. bmj.com 2012. www.bmj.com/content/344/bmj.e2364/rr/584404.6 Setel PW, Macfarlane SB, Szreter S, Mikkelsen L, Jha P, Stout S, et al. A scandal ofinvisibility: making everyone count by counting everyone. Lancet 2007;370:1569-77.7 Ramesh R. GP practice “offloaded vulnerable patients to save money.” Guardian May31. www.guardian.co.uk/society/2012/may/31/gp-health-reform-cost-cut.Cite this as: BMJ 2012;344:e4141© BMJ Publishing Group Ltd 2012a.pollock@qmul.ac.ukFor personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribeBMJ 2012;344:e4141 doi: 10.1136/bmj.e4141 (Published 18 June 2012) Page 1 of 1LettersLETTERS

NHS data in the time of reform: Authors’ reply to Soljak

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