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Government abandons raft of GP access targets

By Gareth Iacobucci

The Government has lit a huge bonfire of GP targets with those on 48-hour access, extended hours and 18-weeks from referral to treatment all to be dramatically scrapped.

Ministers have gone further than any observers had imagined in purging the NHS of the targets of the Labour era, with the two-week cancer rule among only a handful of high-profile measures to be retained.

The Department of Health's NHS Operating Framework for England abandons performance management of GP access with immediate effect, meaning PCTs will no longer be able to pressure practices over their performance on extended hours or urgent care.

Practices will no longer need to guarantee access to a GP within 48 hours and to a primary care professional within 24 hours, with a senior Government source telling Pulse the move is part of wider plans to scrap the entire patient survey, and replace it with a network of local watchdogs (see page 2).

But the moves, revealed in a shock DH announcement this week, leave huge questions hanging over the future of the funding currently ploughed into QOF targets for the PE7 and PE8 survey questions and the extended hours DES.

The new operating framework effectively abolishes the 18-week referral to treatment target by removing all performance management of it, and is likely to precipitate a sweeping rethink of referral management schemes.

It also substantially scales back the four-hour A&E target, with the threshold of acceptability moved down from 98% to 95%.

The squeeze on NHS management costs will be even deeper than had previously been proposed, with the DH pushing for a 46% reduction by 2013/14.

The framework enshrines the coalition's commitment to a moratorium on plans to shift services from secondary to primary care that do not have support from GP commissioners. PCTs are urged to press ahead with Transforming Community Services, but with any plans to be subject to GP approval.

Health secretary Andrew Lansley said: ‘I want to free the NHS from bureaucracy and targets that have no clinical justification and move to an NHS which measures its performance on patient outcomes. Doctors will be free to focus on the outcomes that matter – providing quality patient care.

‘But I want to be clear – while the NHS will no longer be accountable to ministers or the Department for its performance in these areas, it will be very much accountable to the patients and public it serves. Patients will still be entitled to rights under the NHS Constitution and the quality of their experiences and outcomes are what will drive improvements in future.'

Dr Peter Swinyard, chair of the Family Doctor Association and a GP in Swindon, said the scrapping of ‘perverse' process-driven access targets would allow GPs to place more focus on what their patients really wanted.

He said: ‘Chasing artificial targets may decrease the quality of care.'

NHS Targets on the bonfire

- Practices must guarantee access to a GP within 48 hours and to a primary care professional within 24 hours
- At least 50 per cent of GP practices in each PCT must offer extended opening to their patients
- No patient to wait more than 18 weeks for outpatient appointment
- 4 hour A&E target threshold reduced from 98 per cent to 95 per cent.

Source: Department of Health revised operating framework

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