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PCTs to launch renewed blitz on ‘dysfunctional’ GP practices



By Gareth Iacobucci

NHS managers have been urged to clamp down on GP referral rates and local A&E admissions as part of a renewed blitz on ‘poor performance’ in general practice.

A document circulated to PCT bosses by NHS Primary Care Commissioning, which provides commissioning and contracting support to NHS trusts and the Department of Health, outlines a step-by-step guide to weeding out sub-standard GPs, urging managers to look for evidence of behavioural issues, lack of clinical capability or ‘dysfunctional organisations’.

The renewed push comes after Pulse first revealed in May that GPs who work in areas with high A&E attendance were being handed red ratings on hugely controversial ‘traffic-light’ balanced scorecards, which could put their contracts at risk.

The national rush to implement scorecards had looked to have stalled following health secretary Andrew Lansley’s moves to transfer local decision-making powers away from PCTs and into GPs’ hands.

But the renewed push aligns with calls from the National Association of Primary Care for GP consortia to hold individual GP contracts, with the power to terminate the contracts of those who fail to pass tough new performance management measures.

The PCC document says GPs should be measured on secondary care referral rates and their patients’ use of A&E and out-of-hours services.

Managers are also encouraged to look for ‘lack of investment’, ‘dysfunctional culture’ and ‘ineffective teams’ when conducting contract reviews.

It also urges PCTs to ensure they are savvy in knowing the minutiae of GP contracts when imposing sanctions.

It says: ‘It is very important to go by the book, or you will trip up later. Use the GMS and PMS regulations – they are more helpful than you think.’

But Dr Chaand Nagpaul, GPC negotiator and a GP in Stanmore, northwest London, urged PCTs to be ‘very careful’ in how they interpret data on areas such as referrals and A&E admissions.

He said: ‘The information on things like referrals needs to be validated and compared like-with-like.’

Dr Nagpaul urged the Government to look beyond ‘crude’ traffic-light style ratings when advising on how to performance-manage GPs in the future.

He said: ‘GPs were looking forward to the end of a target-driven culture. We don’t want to replicate the simplistic balanced scorecard approach, that wasn’t trying to identify improvements. What we need is something more mature.’

PCTs’ step-by-step guide for performance managing GPs

• Assess the risk to patients and act quickly if necessary
• Find out the cause, as well as the nature of the problem, e.g. with organisational performance, poor individual performance
• Keep a journal
• Use valid information including QOF assessment, patient surveys, referral rates, A&E admissions
• Know the rules
• Involve directors, clinicians and your expert networks
• Aim for improvement before sanctions
• Be proportionate
• Follow-up, sustain and share

Source: NHS Primary Care Commissioning

To read the full document, please click here.

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