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Threat to GPs' 'light touch' monitoring

Promised 'light touch monitoring' of GP performance against the quality framework is under threat

after PCOs were told not to scrutinise their own GPs.

The NHS Confederation's lead negotiator on the quality framework has instructed 12 PCTs to use other trusts to monitor their GPs because of fears they will not crack down hard enough.

Dr Tony Snell, director of clinical effectiveness at Birmingham and the Black Country strategic health authority, said there was a 'potential conflict of interest' if clinicians working for a PCO monitored GPs in their own area.

The move contradicts GPC and NHS Confederation policy on the issue. Both have condemned the move.

Dr Snell said there needed to be 'clear gaps between who is doing the monitoring and who is going to be monitored'. He added: 'My 12 PCTs have been told that because of questions of conflict of interest they should make arrangements with other PCTs.

'There are significant financial implications and from experience in Kent those that know each other behave differently. They are not prepared to make significant decisions that would affect the livelihoods of their colleagues.'

Dr Snell devised the Primary Care Clinical Effectiveness project, a prototype for the quality framework, in Kent. It detected 'significant levels' of GPs using exception reporting as a loophole to achieve pay targets when it began in 1996.

But the NHS Confederation and GPC said getting other trusts to monitor GPs had 'not been agreed' in the contract talks.

GPC joint-deputy chair

Dr Hamish Meldrum said: 'I do not see why it would have to be done by a neighbouring PCT.'

An NHS Confederation spokesman said the contract was about a 'more mature and higher trust relationship' between GPs and trusts. He added: 'There should therefore be no need for neighbouring PCTs to be involved.'

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