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At the heart of general practice since 1960

No-star GPs braced for crackdown

PCTs awarded three stars in the Government's performance league tables are promising to reward GPs for their part in the success.

But as GPs in three-star trusts expressed doubts over how much of the bonus would be seen in their practices, those in areas that failed to gain a single star braced themselves for a crackdown on their performance.

GPs in top-rated trusts called for the bonus to be used to pay them for enhanced services. But the Department of Health said the cash could be used for enhanced service capital projects but not to pay GPs.

Dr Cath Robinson, professional executive committee chair of three-star rated Norwich PCT and a GP in the city, said she hoped its £500,000 bonus could be used to help fund a PFI hospital, freeing up cash for primary care.

'If this is actually going to be real money it could make a huge impact on out-of-hours provision or enhanced services,' she said. 'I almost want to see the whites of its eyes before we spend it, but it's a real morale booster.' But Dr Robinson expressed sympathy for GPs in deprived areas, whose trusts had been judged more harshly. 'It's not fair the way it is. Indicators measure the performance of the trust which is not necessarily how the health of the population is,' she said. 'If there's a deprived population you know there's a higher morbidity and access to services is more difficult.'

Dr John Preston, professional executive committee chair on Durham and Chester-Le-Street PCT ­ which received a £250,000 bonus for winning three stars ­ said the trust would stand by its pledge to plough the money back into its 17 GP practices.

Meanwhile lower-rated trusts moved to reassure GPs they would not take the blame.

Dr Sue Allan, professional executive committee chair for zero-rated Ealing PCT, said: 'GPs are doing their utmost and have improved enormously but there's no reward for effort. It's unfair. We are trying to think of ways to take pressure off practices to work things out for next year.'

Three stars

Dr Gareth Richards hopes the £250,000 bonus awarded to his PCT for winning three stars will free up cash to pay GPs for enhanced services. The Department of Health has restricted use of the cash to funding capital projects.

But Dr Richards, professional executive committee chair on Central Suffolk PCT and a GP near Ipswich, said the bonus would ease budget pressures and increase the prospect of the trust commissioning enhanced services from GPs.

'Enhanced services must be a priority,' he said. '[The bonus] could fund an MRI scanner in a van, or a slit lamp for ophthalmology. That would take the pressure off hospitals and give greater access to things done by GPs and those with special interests.'

No Stars

Dr Ivan Benett says the unfair system to grade performance has left GPs in zero-rated Central Manchester PCT 'deflated' by the failure to acknowledge their hard work.

Dr Benett, professional executive committee chair on the trust and a GP in Whalley Range, said the area had suffered from historic under-

investment that would now be compounded as three-star trusts were given hefty bonuses.

'We want to get to a one- or two-star rating next year, but deprivation has not been taken into account at all,' he said.

'Capital bonuses to three-star trusts will demotivate the staff here. Everybody feels like they are chasing their tail and to have been given no acknowledgement of their hard work is crazy.'

Best and worst performers

Three-star trusts Amber Valley, Bassetlaw, Bexhill and Rother, Broadland, Carlisle and District, Central Suffolk, Cheltenham and Tewkesbury, Cheshire West, Chesterfield, Chorley and South Ribble, Craven, Harrogate and Rural District, Durham and Chester-Le-Street, East Staffordshire, Eden Valley, Ellesmere Port and Neston, Exeter, Greater Derby, Herefordshire, High Peak and Dales, Huddersfield Central, North Bradford, North Lincolnshire, North Norfolk, North Sheffield, Northumberland Care Trust, Norwich, Poole, Preston, Rushcliffe, Selby and York, Sheffield South West, Sheffield West, Shropshire County, South and East Dorset, South Cambridgeshire, South Hams and West Devon, South Huddersfield, South Somerset, Southern Norfolk, St Albans and Harpenden, Stockport, Teignbridge, Torbay, West Lincolnshire, Wyre Forest

No-star trusts Barking and Dagenham, Bath and North East Somerset, Bedfordshire Heartlands, Central Manchester, Chingford, Wanstead and Woodford, Dartford, Gravesham and Swanley, Ealing, Eastern Leicester, Guildford and Waverley, Harrow, Hinckley and Bosworth, Hounslow, Kennet and North Wiltshire, Milton Keynes, North East Oxfordshire, Reading, South Manchester, Thurrock, Vale of Aylesbury, West Wiltshire, Windsor, Ascot and Maidenhead, Wokingham

Star ratings are based on PCTs' performance against nine Government targets using a three-point scoring system and on 37 performance indicators, measured on a five-point scale

Key targets include:

 · Access to a GP

 · Single telephone access implementation plans for

out-of-hours

 · Four-week smoking quitters

Key performance indicators include:

 · CHD audit  · Flu vaccinations  · GP appraisal

 · Generic prescribing

 · Diabetes services baseline assessment

 · Percentage of GP practices offering shared care for substance misusers

 · Change in teenage pregnancy rate

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