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New inspectors set to scrap star ratings and close PCTs

Star ratings face the scrapheap in two years but PCTs are bribing GPs to boost them ­ Rob Finch reports

The 'blunderbuss' approach to inspecting GPs' performance will be abandoned and PCT star ratings are likely to be scrapped within two years in an overhaul of the Government's controversial NHS inspection regime.

Senior officials at the new Healthcare Commission ­ which took over the functions of the Commission for Health Improvement last week ­ launched a scathing attack on the existing inspection system and said their opinion of star ratings was 'not rosy'.

But they warned poorly performing PCTs to brace themselves for intense scrutiny as the commission abandons the 'one-size-fits-all' system in favour of targeted spotchecks in problem trusts. In extreme cases, PCTs will be shut down.

The commission has inherited a commitment to retain PCT star ratings until 2005 ­ despite a recent CHI investigation that conceded they were biased against GPs in deprived areas.

Dr Jonathan Boyce, a senior official overseeing the switch of powers from CHI to the commission, suggested star ratings were likely to be dumped at the first opportunity. 'We are not very keen on them and we will have to do something about them,' he told the annual meeting of the Primary Care Society for

Gastroenterology last month.

Dr Boyce said CHI had a 'tendency to go everywhere ­ a blunderbuss approach' whe-reas the new commission would use 'intelligent information' to target inspections.

Graham Capper, former head of communications for CHI and now head of external communications for the new Healthcare Commission, said a 'legal straitjacket' had forced CHI to inspect every trust in England on a rotating basis.

In a stark warning to PCTs, Mr Capper made clear the new commission would not flinch from using its powers to name and shame poorly performing trusts and recommend their closure to the Health Secretary.

'He could then choose to sack all the staff ­ it's a big stick that we hope we don't have to use, but we're not afraid of controversy.'

GPs offered £100 bribe to help win extra stars

GPs are being offered a £100 reward for every smoker who quits in a desperate bid by a primary care trust to improve its star rating.

Brent Teaching PCT in north London told GPs they could claim £100 for every patient who quit for four weeks after referral to the smoking cessation service.

'For Brent to improve its star rating we need to increase the number of smokers quitting smoking,' said PCT chief executive Dr Lise Llewellyn in a letter to GPs.

GPC deputy-chair Dr Hamish Meldrum said: 'Doctors are keen enough to help patients give up smoking without being offered a £100 bribe in a Mickey Mouse scheme.'

Dr Tim Lancaster, a GP in Oxford and co-ordinating editor of the Cochrane tobacco addiction review group, said: 'I'm not aware of any evidence that offering cash incentives to GPs will work.

'The likelihood of patients giving up smoking as a result is very small. There are so many other factors involved in giving up smoking, regardless of whether a GP gets a fiver or not.'

Brent LMC chair Dr Gillian Braunold said: 'The whole thing is farcical.'

Other PCTs have launched similar schemes. In Harrow, GPs were given £5 for every patient referred to the smoking cessation service while South Somerset PCT offered £100 of shopping vouchers to staff who quit.

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