Hunt to free up 14m GP appointments and impose Ofsted-style NHS rating

Health secretary Jeremy Hunt has confirmed plans to cut bureaucracy in general practice and liberate millions of appointments wasted on re-referring patients who miss hospital visits, but has faced criticism over plans for a new CCG-level NHS ratings system.

Health secretary Jeremy Hunt: plan to cut GP bureaucracy
Health secretary Jeremy Hunt: plan to cut GP bureaucracy

Speaking at the annual Health Service Journal lecture in London, the health secretary set out a four-point NHS England plan to free up GP time and increase capacity by ending re-referrals to hospitals and creating a unified GP payments system.

The revamped GP payments system will bring together all practice transactions, reducing the bureaucracy of chasing income from multiple organisations. Many practices report significant problems with chasing payments from multiple organisations, while the BMA says 14m GP appointments a year are wasted on re-referring patients to hospital.

But Mr Hunt was challenged by RCGP chairwoman Dr Maureen Baker over his announcement of Ofsted-style ratings for CCGs.

From June 2016 local health areas will be given a rating of outstanding, good, requires improvement, or inadequate as an overall rating and for cancer, dementia, diabetes, mental health, maternity and learning difficulties.

NHS ratings

Ratings would be decided by expert committees, Mr Hunt said, rather than using computer algorithms to aggregate scores. 

But Dr Baker warned that aggregate measures could ‘mask poor performance in individual indicators and thus not be meaningful’.

‘I'm afraid I don't see how a committee that puts an Ofsted rating against this will do anything to mitigate that risk,' she told the health secretary.

West Essex CCG chief officer Clare Morris said her ‘heart sank’ at the announcement. ‘I think it will be very difficult to bring the talent to CCGs that we need with that kind of thing over their head.’

Mr Hunt responded that the system was similar to that used for CQC hospital inspections to aggregate ratings.

Map: GP CQC ratings

‘That becomes a very useful, general piece of information,' he said. ‘But we know, of course, a hospital that gets a good rating may have some areas that are less good and some areas that are better. But it gives you an overall picture of the quality of leadership in an organisation if you come to that judgment.’

Mr Hunt added that the key insight from the KIng’s Fund’s work on CCG accountability was: ‘If you are going to do that aggregation, is shouldn't be done by computer algorithm, it has to be done by someone looking at data and interpreting it and understanding it. And that is why we are trying to set up these processes.’

Mr Hunt’s lecture focused on the changes being wrought on the NHS by advances in technology and the use of data. He told health leaders that patients would be empowered by the coming changes and that the NHS should and could be at the forefront of change.

By 'running faster' towards that destination, he said, the NHS was 'more likely' to be able to cope with the pressures doctors and nurses face on the front-line now.

NHS reforms

Mr Hunt said patients would never be powerful if doctors do not have time to listen. NHS England, he said, would implement a four-point plan to help GPs by: 

  • 'Firstly by cutting down on the ludicrous amount of time they have to spend chasing different organisations for payments by allowing everyone access to the GPs' own payment system.'
  • 'Secondly to stop the pointless referrals from hospitals back to GPs when they miss an appointment. A total waste of professional time which accounts for around 3% of all GP appointments.'
  • 'Thirdly we must make general practice truly paperless by 2018 and end the embarrassment that we believe that currently the NHS is the world's largest purchaser of fax machines. Just two hours a week returned to each GP through rooting out bureaucracy and smarter use of technology is equivalent to a 5% increase in total GP capacity. That must be something worth going for.'
  • 'Finally we need to support GPs to innovate locally across organisational boundaries. An independent review of the PM's Challenge Fund has shown a statistically significant 15% reduction in minor self presenting A&E attendances by patients at those practices. This is family doctoring at its best, keeping people happy and health outside hospitals.'

My Hunt also said the government would do more to 'ensure the public get clear information about the quality of their local GP surgery, informed by the Health Foundation’s work'.

Earlier this month a Health Foundation report advised against the development of practice 'scorecards' and composite performance indicators.

Photo: Pete Hill

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