Editorial: How can PCTs fail despite GPs' success?

We all know that quality scores are high across the UK, confirming that chronic disease management in primary care is highly successful. Indeed, the DoH has used the quality framework to illustrate ‘its' successes in tackling conditions such as diabetes and CHD.

So, one can be forgiven for being ever so slightly perplexed when looking at the Healthcare Commission’s PCT ratings. These tell us that fewer than half of PCTs in England are meeting targets for CHD and diabetes. Yet, this is the same England in which GP quality scores are over 1,000.
Let’s get this straight. The same doctors, with the same primary healthcare teams, in the same locations are seeing the same patients with the same chronic diseases and the same outcomes. One of the outcomes being that this same care is simultaneously a roaring success and a dismal failure — according to what are effectively both sets of government figures.
We’ve all heard of lies, damned lies and statistics, but this is bordering on the ridiculous.
The problem is that PCTs are judged against different targets from those in the quality framework.

Yes, that’s right; GPs are working to a set of targets, stringently developed and argued over, that are intended to improve the health of the chronically ill. Vast numbers of man hours and millions of pounds have been invested in this process.
But the Healthcare Commission has its own views on quality and is using criteria outside the quality framework.

It may be these are valid targets: it may be that GPs are already meeting them. However, because the efforts of reporting and data collection have gone into the quality framework, PCTs lack the evidence to show progress on them.
Back in the early days of New Labour government ministers often referred to the idea of ‘joined-up thinking and joined-up government’. Such thinking is clearly missing in this process. The Healthcare Commission and the quality framework review must work together to agree a set of targets that all in primary care can aim for.

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