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RCGP presides over 'star ratings' fiasco

By Joanna Clarke-Jones

'Star ratings are the work of the devil.' This comment from NHS Alliance chair Dr Mike Dixon sums up the horror of a crude measure of GPs' ability, skills and dedication.

Essex LMC chair Dr Brian Balmer was equally bemused at the 'harebrained' idea of adopting a system only recently dismantled for hospitals.

Media reports last week revealed how the RCGP had proposed a 'Michelin-style' ranking system, giving patients an 'above-the-door' guide to surgeries' quality.

RCGP chair Professor Mayur Lakhani said every practice would be expected to participate over time. An inspection team would visit the practice, awarding level one, two, or three status as a measure of all-round performance.

With grassroots GPs and the BMA avowedly against the idea, the descent into what became a PR disaster for the college began.

On the backfoot, the college distanced itself from the idea in a desperate attempt to restore some credibility.

Yes, it had drawn up plans for a new accreditation scheme, following publication of the White Paper on care outside hospitals, which would see GP practices rated at three different levels.

No, it was resolutely not a star rating system, it claimed.

The following day the college went one stage further, claiming the idea of star ratings had been 'sold' to national newspapers behind its back by the Department of Health.

At a press conference in a desperate bid to pour cold water on the issue, Professor Lakhani said: 'In view of the major concerns and feedback received about GPs being very anxious about the scheme, I have decided to review the project and have suspended discussions with the department for the time being.

'This is to ensure the scheme is not misused. This story has not emerged from the RCGP.'

The college then felt obliged to clear the air by writing to all its members to update them on the situation.

But the department passed the buck back to the college, saying 'any talk of Government involvement at this stage is premature'.

Meanwhile, the department has confirmed that it is committed to a patient-friendly quality grading scheme for practices.

Hospital star ratings were introduced in 2001 for hospitals, primary care trusts and ambulance services, where trusts were inspected and assessed against a number of key targets.

The system attracted widespread criticism for creating a two-tier system, rewarding the best-performing trusts and demoralising staff in 'failing' trusts.

The Healthcare Commission has this year adopted a more softly-softly approach, replacing the system with an annual health check, based on self-

assessment and patient surveys.

Dr Dixon, a GP in Cullompton, Devon, said star ratings were completely discredited and would put a 'straitjacket' on practices to meet parameters that do not necessarily reflect what patients want.

'An inner-city practice going from level one to level two might be a far greater achievement than a level two practice achieving excellence,' he said. 'What we must do is look for improvements and encourage practices to move on and get better.'

Dr Balmer said the idea of star ratings was crazy.

'It's completely the wrong time to even discuss it,' he said. 'It's only the third year of the new quality framework and that should just be given the chance to bed down before bringing in something else.'

Indeed it is the very existence of the quality framework which prompted the GPC to accuse the Government of trying to 'reinvent the wheel'.

Dr Hamish Meldrum, GPC chair, questioned why 'crude' measures were needed when the quality and outcomes framework already measured practice performance.

The RCGP says it will now proceed independently on the development of quality standards. Around 1,000 practices have already piloted the system and it is envisaged a larger-scale trial may start in August.

RCGP vice-chair Professor Nigel Sparrow said its idea was based around a 'professionally-led model of assessment', geared around its Quality Team Development (QTD) scheme and the Quality Practice Award.

The scheme, which will still see practices graded at three levels, would encompass 'all of the QOF and more', including adherence to NICE guidance and NSFs and team development, he said.

Most practices should be able to achieve level one, following assessment during a 'light-touch visit'.

Level two would reflect the performance and ability of a training practice and level three a level of excellence in line with the RCGP Quality Practice award.

'It is not star ratings, perish the thought,' insisted Professor Sparrow speaking before the college was forced to suspend discussions with health minister Lord Warner.

'If the Government wants to see it that way they should not be asking the college to do the work. The ethos is to encourage progression and continuous improvement.'

Practices would not be obliged to display Michelin-style stars but could choose to 'show if they have achieved excellence' in some way.

For all the backtracking, a bad week for the college has not assuaged the concerns of many GPs.

Professor Martin Roland, director of the University of Manchester's National Primary Care Research and Development Centre, said he had concerns about using the QTD scheme for a purpose it was not designed for.

Dr Michael Taylor, chair of the Small Practices Association, said the perception would remain that accreditation is simply star ratings by another name. 'The RCGP has made a bit of a medicopolitical booboo,' he said.

A star is born ­ or is it?

6 June

The Times and the Daily Mail claim GPs will face 'Michelin-style' star ratings. RCGP issues details on practice accreditation scheme and says it is in discussion with ministers. GPC accuses it of 'reinventing the wheel'.

7 June

GPs in uproar over prospect of a discredited, crude system. RCGP issues statement denying its scheme amounted to star


8 June

RCGP accuses Department of Health of leaking the idea of star ratings to the press. College pledges to 'go it alone' in developing standards.

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