Exclusive: ‘Worst-performing’ GP practice data based on just one month

Exclusive The data NHS England has given ICSs to help them identify the 20% of local GP practices to face action on access is based on a one-month ‘snapshot’, Pulse has learned.

ICSs were told to identify the 20% of practices that were performing worst on a range of metrics, including percentage of GP appointments that were face-to-face, CQC complaints data and the rates of 111 calls from their patients during GP hours and of A&E attendances ‘compared to what would be expected’.

They were also asked to identify ‘any practice’ with overall appointment numbers lower than in the ‘equivalent pre-pandemic months’, excluding Covid vaccinations.

But it has emerged that the data NHS England has passed down to ICSs to help them with this exercise is solely based on performance in August 2021 compared with August 2019, with GP leaders expressing concerns about the ‘rubbish’ quality of the data.

It remains unclear which of the metrics this data covers.

North and South Essex LMCs chief executive Dr Brian Balmer told Pulse: ‘[It’s a] one-month snapshot – rubbish. 

‘It’s not meant to be scientific, this is a witch hunt. They don’t care who’s guilty or innocent.’ 

Liverpool LMC medical secretary Dr Rob Barnett added that comparing August in 2021 and 2019 means the snapshot is not of a ‘typical month’.

He said: ‘The problem is they are comparing August which is holiday time and this year more than any other we have encouraged people to take a break because they haven’t had one, so it’s just nonsense. 

‘And the way information is being recorded now is very different to the way it was recorded two years ago because of GP access data requirements, so they’re not comparing like with like.’

He added that the local CCG ‘doesn’t believe in the data’ and is ‘aware of the limitations’, but that its ‘hands are tied’.

He told Pulse: ‘It doesn’t feel positive at all – this is not good for practices who find themselves at the naughty step especially if they’re not particularly naughty. The question is how is this going to be done in a way that doesn’t demonise people. 

‘The CCG is very aware of this. This is a box-ticking exercise mandated by the secretary of state and people are doing what they have been tasked to do, but what we have got to do is make sure resources come into Liverpool and are used in whatever way they can be used.’ 

Dr Barnett added that those he has ‘spoken to at the ICS level have found this whole process very uncomfortable and distressing’.

There is a local understanding that some funding could be used ‘on a city-wide basis’ while some will have to be ‘earmarked’ for certain practices, but ‘no one knows the answer’ as to how they can ‘make sure the money isn’t lost’, he added.

Dr Balmer also told Pulse that local CCGs in his area also think the exercise is ‘complete rubbish’.

He said: ‘Every LMC I have spoken to has said that their colleagues in CCGs think this is mad and potentially destroys relationships that have taken years to build up.’

The identification of practices in this way is ‘probably the worst policy [he’s] ever seen’ and ‘certainly the most divisive’, he added.

Dr Balmer reiterated that the LMCs will ‘challenge’ the data ‘in every way possible’.

He said: ‘We’re going to question every step they take, we’ll challenge the data, the legal basis, the contractual basis – which there isn’t one – how they pick up on people who are not fulfilling their contracts.’

NHS England was approached for comment.

A spokesperson told Pulse on background that the figures are not intended to be the only data used to identify practices needing additional support, but should be supplemented with any local data.

NHS England last month said that a ‘combination of data sources’ would be needed to identify practices for this list, and conceded that the NHS Digital appointment data is ‘experimental’ and has ‘issues’.

However, it did not set out what other data ICSs should use.

Under NHS England’s GP access plan, ICSs were told to submit a list of the 20% of practices in their area that are performing worst in terms of access by 28 October to face ‘immediate’ action.

NHS England and the health secretary have said that these lists identified by ICSs will not be published.

Meanwhile, GPs were last week given until 14 November to respond to a BMA ballot asking what action they are prepared to take against NHS England and the Government’s access plan.

The BMA and some LMCs have advised GPs ‘not to engage’ with the plan, while other LMCs are against the BMA action or still deliberating.