'Impossible' commissioning targets threaten GP practice income

GP commissioners face a huge struggle to hit targets that could affect 15% of practice income, after most hospitals failed to achieve similar goals in a 'trial' of the system.

Dr Vautrey: Commissioning targets are ‘a recipe for widening health inequalities'
Dr Vautrey: Commissioning targets are ‘a recipe for widening health inequalities'

DoH figures show less than half of hospitals are set to reach a goal for assessing patients’ clot and bleeding risk. A consultant criticised the target, saying many hospitals have 'no hope' of hitting them.

Clinical commissioning groups (CCGs) – formerly GP consortia – will be challenged to hit comparable targets to earn a ‘quality premium’ from April 2013.

This will reward good clinical and financial commissioning. Failure to hit the targets is likely to impact up to 15% of practice income.

GP leaders said the figures showed the quality premium idea is flawed and could financially penalise practices for outcomes outside their control.

GPC chairman Dr Laurence Buckman had previously attacked the quality premium. He said linking GP earnings to their CCG’s financial management would be ‘completely unethical’.

Hospitals were paid an incentive based on the proportion of patients assessed on admission for clot and bleeding risk for one year to June 2011. It was designed to improve detection of venous thromboembolism (VTE).

But new figures show just 49% of 176 acute providers in England reached the 90% screening rate in January to March 2011. Providers must average this rate over the year to receive an incentive payment.

A consultant told attendees at NICE’s annual conference in May how the arduous target had forced hospitals to hire staff and divert resources to hit 'tick box' targets, with no evidence it improved care.

Consultant Sarah Barton of Salford Royal NHS Foundation Trust said many hospitals had 'no hope' of reaching the target in the first year and warned about the effect of more targets in future.

'If we go from one NICE quality standard to 150, how are we going to cope with the burden of measurement and have a common sense approach so we're not financially penalising lots of trusts? Because they can't do the impossible,' she said.

The target was based on a NICE quality standard for VTE. GP commissioners face similarly tough targets as NICE quality standards will also be used to create indicators for a Commissioning Outcomes Framework (COF) that will feed into the quality premium.

GPC deputy chairman Dr Richard Vautrey said: ‘This is one of the reasons why the idea of a quality premium is wrong.

'It will lead to CCGs, and therefore the communities they serve, being financially penalised simply because they have not achieved a target with an arbitrary standard and over which they have little or no control.’

He added that the plans are ‘a recipe for widening health inequalities and making it more, rather than less, likely that we see hospitals and commissioning groups losing the confidence of the patients they serve’.

Just 16 of 162 independent sector providers provided mandatory data to the DoH in the fourth quarter of 2010/11.

In contrast, 160 out of 163 NHS acute trusts handed over the required figures.

A DoH spokesman said: ‘NHS acute trusts have led the way and we expect commissioners to push other providers to report data.’

The DoH plans to report any providers who fail to make mandatory returns to the Care Quality Commission (CQC) from this summer.

The threat echoes concerns that GP practices may be investigated by the CQC for failing to comply with NICE quality standards, as GP reported in May.

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