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GPs must help reshape hospital care

The NHS must address the alarming variation in the quality of its hospitals, and GPs should be prepared to take a leading role.

Mid Staffs has become easy shorthand, not only for Mid Staffordshire NHS Foundation Trust, but also for healthcare at its most gruesome.

Its emergency care was so ‘appalling' that up to 1,200 people may have died ‘needlessly', according to a regulator's report. Only the NHS's harshest critics would claim Mid Staffs was typical of the health service as a whole, but equally a summing-up last month of the public inquiry into the trust made clear elements of its failings had been replicated elsewhere, and that ‘the tendency within the Department of Health to view Mid Staffs as an isolated example is dangerous'.

In that context, the results of our survey of 500 GPs, conducted jointly by Pulse and its sister title Practical Commissioning, are worrying. They suggest the standard of NHS hospitals is not nearly as uniformly good as the DH would like to believe.

Most GPs are relatively happy with the overall performance of their local hospital, with 78% willing to recommend it, and 74% willing to use it for themselves and their families.

But those overarching figures mask significant, more specific concerns. While 64% of GPs rate clinical care at their hospital as good or very good, only 44% do so for speed and efficiency, and 38% for communication and personal care. An astonishing 15% of GPs – one in seven – regards at least one department at their local hospital as ‘dangerously substandard', and 10% have had a patient die over the last year potentially as a result of substandard care.

Findings like those add weight to concerns that Mid Staffs-style problems could be occurring in a significant minority of our nation's hospitals. But what is more shocking is how little the NHS appears to have learned the most fundamental lesson from the Mid Staffs inquiry – of how vitally important it is that managers listen to clinicians and take action when the alarm is sounded.

A third of GPs said they had raised concerns with the local hospital over the last year, in some cases formally with letters to clinical standards teams. Yet only 42% were confident that when concerns were raised they would be fully investigated and, if appropriate, acted upon.

In a culture where no one listens, no one tells. That is dangerous not only for patients but for GPs too – because when something does go wrong, as with Mid Staffs, the media and politicians are only too quick to criticise GPs for their failure to speak out. Hospitals, and the DH, must snap out of this dangerous complacency and open their ears to potential concerns.

But GPs too have a responsibility, not only to relay their impressions of care, but also increasingly to take steps to reshape it.

We report in this issue of Pulse that GPs in some areas are holding hospitals to account for long A&E waits, while in Practical Commissioning (and on its website practicalcommissioning.net) we detail the measures GPs can take to scrutinise hospital quality.

The NHS must address the alarming variation in the quality of its hospitals, and GPs should be prepared to take a leading role.

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