Excellence not enough for new PCT ratings

GP practices must be some of the most assessed bodies in the country. Appraisal, revalidation, the quality framework, access and immunisation targets, and patient surveys are all intended to measure aspects of GP performance — but these are not enough for some PCTs.

Various PCTs are introducing ‘balanced scorecard’ systems further to measure performance in areas such as access, prescribing and new patient registration. We must assume that this is because they haven’t noticed the other targets and measures in these areas because, obviously, no NHS manager would knowingly sanction such duplication of effort and waste of precious resources.

But it is not just the duplication that is the problem with these new measures; it is the criteria against which practices will be measured — criteria that go beyond what practices are contracted to do.

For example, a practice could hit its access target and therefore perform to GMS standards but receive a ‘B’ on the scorecard because it doesn’t offer extended opening hours. If it also has an open-but-full list — because it is popular, or is in an under-doctored area — the practice could find itself with a ‘C’, regardless of whether it is scoring highly on the range of other measures already in place.

An ‘A’ would require the practice to go beyond its GMS or PMS contract.

In most circumstances, an NHS body managing to deliver all its priorities and gaining a high quality score would be regarded as very good. Not so for a GP practice, which would only be ranked ‘B’. To gain an ‘A’, a practice must go beyond its contract — in other words, work for free to provide extra services.

But it seems unlikely that the public will understand this distinction when the scorecards are published. More likely, people will consider ‘B’-graded practices to be failing in some way.

If PCTs really believe that another assessment system is needed in primary care, they must choose a method that fairly reflects the work of GPs and does not waste valuable NHS resources on reinventing multiple wheels.

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