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Healthcare Commission to consider 'balanced scorecard' system for national practice accreditation model

New performance model planned

A controversial performance management system being used to rate surgeries in London is to be considered for a planned national accreditation scheme for practices.

The Healthcare Commission, which is in talks with the

Department of Health and RCGP over an accreditation model, has pledged to look at a 'balanced scorecard' system

being used in east London.

Under the system developed by Tower Hamlets PCT, practices are rated annually against 19 indicators, including access, how many patients visit A&E and the clinical and cost-effectiveness of their prescribing.

Each indicator will be scored A, B or C and the results published on the PCT's website.

A PCT document states: 'Where the PCT's formative and facilitative approach results in either lack of co-operation for improvement or lack of pro-gress, the PCT will use its commissioning powers to require improvement.

'This will include use of remedial notices, and eventually, removal of the contract where there is documented evidence of lack of improvement.'

Under one indicator, under-doctored practices will have to defend why this is the case and take action to remedy the situation, unless they are using skill-mix or have less income than similar practices.

A spokesperson for the Healthcare Commission said: 'This is quite a proactive initiative. This is one sort of model we would look at and consider.'

Andrew Ridley, director of primary care at Tower Hamlets PCT, said the trust had wanted to give practices a single rating, but the LMC had deemed this 'too crude'. He said: 'We have tried to make sure it is not too onerous on practices, so we have chosen measures for which we would have data anyway.'

The PCT presented the system as a model other trusts could use at a recent NHS conference.

Dr Kambiz Boomla, a member of Tower Hamlets LMC, said the LMC had not agreed with some of the indicators, but gave the go-ahead to the scheme on the basis that it was transparent. He said: 'Obviously the

concerns are that it will give

the PCT some basis for issuing remedial notices.'

The RCGP is pushing for any national accreditation system to be voluntary and based on its Quality Team Development model.

Professor Nigel Sparrow, vice-chair of the RCGP, said: 'General practice should be assessed in a holistic way with professionally led schemes that have credibility and academic rigour.'

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