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Traffic-light ratings are a dangerously crude crackdown

Practices are seeing red over traffic-light ratings – and the poorest performers face losing their contracts. Surely that's not the solution to improving quality of care?

Practices are seeing red over traffic-light ratings – and the poorest performers face losing their contracts. Surely that's not the solution to improving quality of care?



Red is for danger, and by that count GP practices must be dangerous places indeed. PCTs across England are busy preparing traffic-light ratings of practices, under a Government-mandated programme of contractual reviews, and almost everyone seems to be getting a red rating for one category or another.

It would be easy for GPs to dismiss the results as just another overblown exercise in bureaucracy, if the consequences of being labelled a failure weren't so severe. As Pulse reveals this week, practices rated red for the access domain are receiving a visit from a team of management consultants, and NHS managers are openly declaring that they plan to cancel the practice contracts of those who fall short of the required standards.

The series of reviews fall under the Government's World Class Commissioning initiative, which is neither as bland nor as harmless as it sounds. WCC is a systematic and aggressive drive to assess every provider in the NHS, to ensure each one is providing value for money and fulfilling the terms of its contract. There is no room for sentiment here – longstanding practices will be assessed on exactly the same terms as private providers and the new wave of GP-led health centres. GPs who fall short can expect to be forced to work under schools-style special measures, if they're lucky enough to still be working at all.

Now the aims of WCC are laudable enough – to achieve a sleek and cost-efficient health service, while dragging up standards among those providers that have consistently underperformed. The means, however, are quite another matter. Forget developmental appraisal, formative assessment and a partnership approach to quality improvement – this is straight out of the big-stick school of management. It all feels rather like an episode of The Apprentice, but while Sir Alan Sugar may now be a Government tsar, there must be serious questions over whether telling GPs ‘you're fired' is the best way to raise standards in primary care.

PCTs need to remember that clamping down on substandard providers is not the only task the Government has handed them in the past few months. The Department of Health has also told trusts it expects them to make a concerted effort to develop clinical leadership opportunities and liaise effectively with general practice. Good GPs share an interest with trusts in ensuring the worst practices get better or are removed, since substandard doctors damage the reputation of the whole profession. A process led by GPs, in which underperforming practices are given the support they need to improve, could have real benefits for the health service. By contrast, crass rating systems will succeed only in providing patients with a misleading impression of general practice, while crude contractual threats will drive a yet deeper wedge between managers and doctors.

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