Rate Your PCT: Are NHS markets ruining relations?

GP's Rate Your PCT survey finds GPs in Scotland and Wales far happier with managers. Prisca Middlemiss reports.

Dr Marshall: 'There is a better degree of jointworking between GPs and PCOs in Scotland'
Dr Marshall: 'There is a better degree of jointworking between GPs and PCOs in Scotland'

GPs in Scotland and Wales have a far better relationship with their primary care organisation (PCO) than their colleagues in England.

Practices in the devolved administrations are between two and three times as likely to say their PCO enjoys their confidence as practices in England.

Welsh and Scottish PCOs outperformed those in England in almost every aspect of their relationship with practices, GP's 1,650-response Rate Your PCT survey has revealed.

The outcome appears to be a damning indictment of market reforms in England, with English GPs most vocal in their criticisms of political interference and imposed competition.

Stark contrast
Scottish GPs are most upbeat. Forty-three per cent of Scottish practices gave their PCO a vote of confidence - in stark contrast to England, where a mere 15 per cent said they had confidence in their PCT. 'There is a better degree of joint working. We don't have huge ideological differences,' says Scottish GPC chairman Dr Dean Marshall.

Scottish PCOs were rated better than English PCTs on almost every measure. Staff's helpfulness and understanding of practice needs were more than three times as likely to have an 'excellent' rating.

Staff availability - are they there when you call? Does your email get an instant answer? - was rated more than twice as good.

Overall support for practices was rated as 'good' or 'excellent' by 40 per cent of Scottish practices - but by just 18 per cent of English practices.

For transparent financial management, inspiring leadership, effective communications and for continuing professional development, Scottish PCOs were rated more than twice as highly as English PCTs.

Confidence in the Welsh local health boards (LHBs), now amalgamated into larger boards, was almost as high.

Praise was not unalloyed, but one Conwy GP wrote: 'Great team to work with.'

GPC Wales chairman Dr David Bailey says governments in the devolved administrations are 'less hostile, leading to GP-friendly innovative policies being far less likely to be stamped on'.

Not a single GP in Scotland or Wales complained about top-down 'diktats', a frequent complaint in England. Not one comment from a Scottish or Welsh practice even hinted at the vitriol that permeated comments from English GPs. 'Fair but faceless,' a GP principal wrote of NHS Lothian.

Most LMCs have 'good' or 'very good' relationships with their PCO, Dr Marshall says.

Response rates from Wales and Northern Ireland were low - perhaps because health boards were being scrapped when GP's survey was opened last October.

Wales leads the field in some aspects of PCOs' relationships with practices, such as inspiring, innovative leadership.

Almost a quarter of respondents said their health board gave 'excellent' support.

'The locality teams from the old LHBs are still in place and personal relationships built up over time,' says Dr Bailey. 'It remains to be seen if relationships with the larger organisations we have now will change.'

Dr Marshall adds: 'Every-thing isn't rosy here. Scottish GPs earn 20 per cent less than English GPs and we suffer from a dearth of good policy.' He says scrapping annual re-negotiation of contracts and agreeing longer term finances would allow Scottish practices to plan ahead.

John Appleby, chief economist at the King's Fund health policy think tank, says the evidence that market reforms have improved healthcare in England is mixed.

Competitive areas
A study from the London School of Economics showed fewer 30-day deaths from acute MI in more competitive areas and concluded that 'NHS market-based reforms saved lives', Mr Appleby says.

'But there are costs to competition. The researchers didn't do a cost: benefit analysis of the reforms,' he adds.

Trying to isolating the impact of reforms is difficult, Mr Appleby says. 'I don't know of any evidence on market- based reforms in primary care.'

The Impact of the NHS Market, a briefing by the think tank Civitas, said evidence on the impact on quality of care is mixed.

The researchers found waiting times reduced, patient access improved and provider efficiency up. But attributing these improvements to market reforms alone was 'questionable'. 'The research suggests the NHS has found itself in a lose-lose situation - taking on the extra costs of competition without experiencing the benefits,' the report concluded.

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