GPs could face Ofsted-style ratings within two years

GP practices could face Ofsted-style quality ratings within two years under proposals in a review commissioned by health secretary Jeremy Hunt.

Jeremy Hunt: commissioned review into NHS ratings
Jeremy Hunt: commissioned review into NHS ratings

The review, published on Friday by health think tank the Nuffield Trust, found a ‘clear gap in the provision of comprehensive and trusted information on the quality of care of providers’.

GPs and social care providers could be the first to be rated, with more complex organisations such as hospitals assessed later, the think tank suggested.

The Nuffield Trust review suggests the ratings should be carried out by health watchdog the CQC, with which GP practices in England must register from 1 April.

BMA chair Dr Mark Porter said the review was ‘refreshingly thoughtful’.

But he warned: ‘There are always going to be problems constructing indicators that measure quality in any meaningful way, and do not result in a target-driven culture.’

He added: ‘GP surgeries often have many staff and offer a range of different services, the quality of which would be difficult to reduce to a meaningful single score.’

The health secretary warned last month that the government must avoid the ‘elephant trap’ of over-regulating NHS providers as it seeks to prevent a repeat of failings at the Mid Staffordshire NHS Trust.

But Mr Hunt could set out plans to impose new NHS ratings as part of the government’s full response to the Francis inquiry, expected next week.

Nuffield Trust chief executive Dr Jennifer Dixon, who led the review, said that existing information about NHS providers is ‘spread across a range of sources’ and difficult for the public to understand.

‘One aggregate, comprehensive rating of providers may provide more clarity and simplicity,’ she argued.

However, the review warned that the government must consider the ‘extra burden a rating may impose on providers, which might detract from patient care’.

Dr Dixon said: ‘Providers are examined so much at the moment you kind of worry whether they can do the day job.’

She told GP that any new general practice rating system could build on existing assessment schemes including RCGP practice accreditation and quality practice awards.

Ratings would focus broadly on patient experience, safety, effectiveness and aspects of clinical governance, and could be in place in 'under two years', she said.

She said if the government went ahead with a new ratings system, it could cover a ‘different range of things, not necessarily more things’ than existing checks.

Precise details would be for the CQC to work out with the profession, she said, but ratings could use data that is already collected routinely.

She argued that ratings could account for differences between practices. ‘There are big differences between practices, and some that are clumping together into federations – so you would have to think how that can be done. I think it is entirely possible to do something along those lines.

‘With different populations we have reasonable systems for risk adjustment, so we are comparing apples with apples. The rating can incorporate that.’

She added that the proposals for ratings set out in the review imply ‘a move away from the current CQC approach which involves lay inspectors’ to using more experienced, specialist inspectors who might ‘get a smell of the place more quickly’.

She said an ongoing review by NHS Confederation chief executive Mike Farrar into how the NHS can cut bureaucracy by a third could be a platform for a ‘zero-base review’ of the existing NHS inspection regime.

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