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At the heart of general practice since 1960

Managers move to axe low-scoring practices under new ratings system

By Gareth Iacobucci

Exclusive: NHS managers have begun moves to terminate the practice contracts of GPs failing to meet stringent access targets, under the Government's national programme of contractual reviews.

PCT lawyers are already working on removing practices judged as the worst performers on traffic-light ratings, with many more expected to work under school-style special measures or handed stringent improvement programmes.

At least five PCTs have now published balanced scorecard results on their websites under the Government's World Class Commissioning initiative, with several more already initiating disciplinary action against some practices.

NHS Barking and Dagenham has become the first to take legal moves against those it has judged not up to standard.

It has spent £650,000 using private firm McKinsey to investigate access at 21 of its practices – out of a total of 43 – most of which had been identified as substandard through patient survey results. All these were rated on a balanced scorecard by McKinsey – which has also been commissioned by the Government to develop a national rating system.

GPs were scored red, amber or green against indicators including number of GP appointments, response times during opening hours and number of manned phone lines per 2,500 patients during peak hours.

Ten practices received an overall red rating, with five only switched to amber after agreeing to a series of measures including increases in total appointments of 50% or more. The trust has now instructed a legal team to begin taking sanctions against GPs, with two practices facing loss of their contracts.

Jemma Gilbert, assistant director of primary care contracting at the PCT, said: ‘The sanctions are applied to people who are far off a reasonable number of appointments per week.

‘Practices have had 28 weeks to undertake the action plan they'd agreed on access, but they just haven't delivered. If they fail, we will look at pursuing contract termination.'

She admitted some GPs ‘felt threatened' by the scheme, but said McKinsey had enabled it to provide an extra 60,000 GP appointments, worth about £1.3m.

Elsewhere, Wandsworth PCT has handed red ratings to nine local practices over their doctor-patient ratios and five on opening hours, and Luton PCT has sent in teams to demand better performance at eight practices.

Hillingdon PCT has given 22% of its practices an overall red rating on clinical indicators.

NHS East and North Hertfordshire recently published scorecards on 61 practices, with 90% getting a red rating for at least one category.

GPC negotiator Dr Chaand Nagpaul was also recently rated on a balanced scorecard at Harrow PCT – where 61% of 38 practices had at least one red rating – scoring amber on opening hours and amber on the two questions on the patient survey.

He attacked the use of the scorecards as a ‘crude' weapon against GPs. ‘It's a nonsensical way of judging doctors. Many are working in practices where poor performance is not a reflection on the GPs, but a host of factors, including poor premises and lack of staffing. Using threats of termination is completely wrong.'

GPC negotiator Dr Chaand Nagpaul GPC negotiator Dr Chaand Nagpaul Red alert for GPs under scrutiny

Practice ranking at the end of McKinsey's access review
10 practices rated red
8 practices rated amber
3 practices rated green

Practice status after follow-up visit
5 improved from red to amber
5 continued to cause significant concern
2 of these facing contractual termination

Source: NHS Barking and Dagenham's primary care access project

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