Rate your PCT: GPs deliver tough verdict on performance of PCOs

GP's Rate Your PCT survey gave GPs facing evermore scrutiny a chance to turn the tables on their primary care organisations. Prisca Middlemiss reports on the results.

Dr Buckman: 'Relationships range from warm and harmonious to not even fulfilling statutory requirements for communication'
Dr Buckman: 'Relationships range from warm and harmonious to not even fulfilling statutory requirements for communication'

Practices have delivered a damningly negative view of primary care organisations (PCOs), covering almost every area of their activity.

More than 1,650 respondents from across the UK answered GP's invitation to score their PCO's staff, attitude, financial management, commissioning, leadership, communications and support for education.

The Rate Your PCT survey gave practices beleaguered by targets, surveys and scorecards a first chance to have their say about NHS managers.

One GP from Swindon said: 'Thank you for doing this survey - first time in years I have been able to say what I think.'

Eighty-seven per cent of the 900 GP partners who responded said their PCT's overall performance was just 'fair' - or worse. Eleven per cent of partners rated their PCT as 'good' and a mere 2 per cent said it was 'excellent'.

Responses were mixed, however. Tower Hamlets, Wirral, Gloucestershire and Somerset had positive comments, as did NHS Greater Glasgow. Cornwall and Isles of Scilly and Brent in north west London were named and shamed.

Sharp contrast
The Rate Your PCT findings are in sharp contrast to the DoH's own assessment of English PCTs' performance under World Class Commissioning.

Results published last year showed that 27 out of 152 PCTs achieved green light ratings for finance, strategy and board governance. Round two assessments are expected in July.

But some GPs say this is the problem, not the solution. A practice manager from Hampshire said: 'The PCT has been ambushed and sidetracked by World Class Commissioning.'

The GP survey showed that, with exceptions, practices feel bullied and unsupported by PCTs that can appear antagonistic and obstructive. More than half of GPs rated their PCT's support of their practice as poor.

Practices give clues as to why they feel so abandoned. PCTs rely too much on targets, systematically underfund, obstruct access to services, impose Darzi centres: scapegoats are legion.

GPC chairman Dr Laurence Buckman - whose relationship with his PCT is so good he's had the chief executive home for tea - points out that PCTs can be supportive in principle but as budgets dwindle, cannot support practices with cash.

Frontline care
A principal from south London praised the PCT's improvements to frontline care, only to comment: 'Unfortunately, the financial package awaiting us in 2010 and onwards is limiting the realisation of these plans.'

The DoH sees this differently. Practices that want support must improve, it says. 'The World Class Commissioning assurance system assesses and holds PCTs to account for engaging clinicians, including GPs, and working with providers to ensure contract compliance and continuous improvements in quality. This includes supporting GPs as providers to improve.'

Many GPs point to a deterioration in their relationship with their PCT. NHS Northamptonshire's clinical chair Dr David Brown says it built a five-year GP strategy 'democratically' with practices.

But one of 34 GPs from the area who responded said it 'used to be supportive and achieved a lot by working with GPs but has now become dictatorial, bureaucratic and bullying'.

Political interference lies at the root of this decline. Dr Buckman says: 'The NHS exists to get governments re-elected', while GPC deputy chairman Dr Richard Vautrey believes: 'PCTs are very often doing what the SHA and DoH are telling them.' He calls for a 'change in philosophy' and more local collaboration.

The DoH does not accept this decline. Its own practice-based commissioning survey shows that GPs report a good relationship with their PCT rose from 72 per cent to 77 per cent in the two years to 2009.

'Poor' commissioner
Respondents to Rate Your PCT were most damning about PCOs' ability to commission effectively. Eighty-eight per cent of respondents rated their PCT's ability to commission effectively as no better than 'fair'. Some 62 per cent of GPs said their PCT was a 'poor' commissioner.

Dr Buckman agrees: PCOs are not big enough to pool their risk or to employ a high enough calibre of contracting expert. He believes the answer is to group PCTs for commissioning as in Wessex, Liverpool and the West Midlands.

Poor PCT leadership in England, Dr Buckman says, is down to SHA interference. GPs delivered a damning verdict on PCTs' ability to provide leadership that is 'positive, innovative and inspiring'.

Almost 90 per cent gave their PCT a negative rating. In entire regions, such as the north east of England, not a single PCT was considered an excellent leader.

'Potential leaders are bullied and threatened by SHAs,' Dr Buckman says. 'Bullying is endemic in the NHS which has a name, shame and blame culture. SHAs are a waste of money and should be abolished.'

The survey revealed remarkable variety within and between PCTs. 'Relationships range from the outstandingly good and harmonious to not even fulfilling statutory requirements for communication,' says Dr Buckman.

In eight regions out of 10, more than half of practices gave a 'poor' rating to their PCT's financial management.

An Oxfordshire GP summed it up by saying: 'Primary care is lean, PCTs are not.'

Case Study: NHS Wirral

16 respondents including 11 GPs. On every measure, responses were better than the national average. Almost half rated the PCT as good or excellent and 33 per cent had confidence in the PCT.

What the PCT said:
'NHS Wirral takes clinical engagement seriously, we are proud of our achievements and pleased this has been recognised. Clinical engagement helps drive up quality and develop services to meet the needs of the patients and population. We work very hard to continuously improve clinical engagement across all professions and have structured our organisation to support this.'

What respondents said:
One practice said: 'Excellent commissioning group' and 'excellent help with completing DoH edicts'. But other comments were more openly critical. A GP principal said: 'PCT fails to consult with LMC; appears only concerned with meeting targets and satisfying DoH initiatives; is secretive about how decisions are made, may give partial or misleading information to GPs. Cronyism within PCT senior management.'


Case Study: NHS Brent

17 respondents from Brent, including 13 GPs. NHS Brent received a 'poor' rating from 100 per cent of respondents on overall performance, attitude, access to staff, ability to commission, financial management, leadership, communications and learning.

What the PCT said:
Jo Ohlson, director of primary care and community commissioning: 'NHS Brent is disappointed. We continue to work to improve our communication with practices and have received recent positive feedback. NHS Brent has come a long way from the poor relationship with primary care highlighted by the independent Taylor report published in February 2008. When Mr Taylor returned in 2009, he said: "My original report stated that improving the relationships with primary care represented a formidable challenge. I believe the challenge has been surmounted, my recommendations met - and in some cases surpassed."'

One GP principal said:
'Brent teaching PCT remains GP-unfriendly. This is a long standing tradition. They are more preoccupied with pleasing the powers above rather than those in the frontline. Last year's outside inspector's report was a total whitewash in which the only GPs consulted seemed to be those on the PCT executive committee.'


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