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GPs face sanctions on A&E attendance under scorecard scheme

By Gareth Iacobucci

Exclusive: GPs who work in areas with high attendance at A&E are being handed red ratings that could put their contracts at risk under the Government's hugely controversial traffic-light scorecard scheme.

Our investigation shows practices are being rated on balanced scorecards by local A&E attendance, levels of emergency and elective admissions and their referral rates.

Of 28 PCTs that have now completed balanced scorecards of local practices, a third have included specific indicators scrutinising A&E attendance, while almost half are rating GPs on emergency admissions and referrals.

The crackdown comes as new figures show that record numbers of people are attending A&E departments in England, with 20.5 million people attending in the last year.

Pulse revealed last month that GP practices were facing a series of punitive measures including suspension of contracts and threat of closure as trusts escalated use of the scorecards, with 80% planning to have them in place by the end of this financial year.

But the scrutiny of A&E admissions and referrals has been criticised by both GPs and academics as particularly unfair, for blaming GPs for factors beyond their control.

At NHS Western Cheshire, one practice in four got the lowest of the three rating categories for attendances at A&E per head of population.

In NHS North Lincolnshire, one practice in five was red-rated on A&E attendances admitted to a hospital bed, with one practice rated red on A&E attendances that were discharged or left without treatment.

Among other trusts rating GPs on A&E attendances were NHS Western Cheshire, NHS North East Essex, NHS Heywood, Middleton and Rochdale, and NHS Hammersmith and Fulham.

Dr Richard Vautrey, GPC deputy chair, warned trusts they were treading into ‘difficult waters' by comparing practices on hospital activity.

‘The problem is scorecards are often very simplistic, and don't interpret the local context sufficiently for patients to be able to make a considered judgement.'

‘Many practices feel there is a limited amount they can do to change admission rates. Often it's to do with where a practice is located geographically rather than what's happening within the practice itself.'

Dr Rod Jones, statistical advisor at Healthcare Analysis and Forecasting, has carried out research suggesting primary care is being unfairly blamed for soaring hospital activity.

He told Pulse including A&E attendance on GP scorecards was indicative of ‘a whole agenda that primary care is the problem'.

Trusts using A&E admissions on GP balanced scorecards

• NHS South West Essex
• NHS Hammersmith and Fulham
• NHS Heywood, Middleton and Rochdale
• NHS Western Cheshire
• NHS North East Essex
• NHS Wandsworth
• NHS North Lincolnshire
• NHS Coventry
• NHS Walsall

GPs face sanctions on A&E attendance under scorecard scheme What GPs are being measured on in your area


View A&E admissions on balanced scorecards in a larger map

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