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GPs face sanctions as scorecards go national

By Gareth Iacobucci

Exclusive: GP practices across the country are facing a series of punitive measures including suspension of contracts and threat of closure as PCTs escalate their use of controversial traffic-light ratings.

A Pulse investigation reveals the Department of Health's balanced scorecard scheme, which rates practices against a range of clinical and organisational indicators, has now been rolled out across 40% of trusts.

A further 40% plan to introduce the hugely contentious rating system during the current financial year, after a set of national indicators were developed for the DH by management consultancy McKinsey.

And where PCTs are using scorecards, some are imposing severe contractual sanctions on low-rated practices. In one case, a practice is facing closure because of its refusal to offer extended hours.

Pulse revealed last October that as many as 70% of GP practices in trailblazer PCTs were failing at least one element of the ratings system, with small practices and those in deprived areas most likely to struggle.

Our latest analysis, of responses from 116 PCTs, finds the number with scorecards in place has soared from just a handful last year to around 50. And managers are increasingly using the scorecards to ramp up pressure on practices.

These include NHS Walsall, which has suspended a GP for failing to meet scorecard stipulations. A spokesperson said: ‘We have used remedial notices for minor surgery, opening times and GP cover. Using information from balanced scorecards has assisted in recent GP suspension and investigation.'

NHS Camden is investigating 16 breaches identified through balanced scorecards. One practice has been warned of a possible default on a remedial notice for failing to ‘ensure that the practice is open for a minimum of 10 hours outside of 9am-6.30pm', and is being warned that it ‘would lead to a loss of contract and possible closure'.

Elsewhere, NHS Greenwich told Pulse: ‘Two practices have been subject to remedial notices due to poor performance' flagged up by their scorecards.

The latest cases come after Pulse revealed last June that NHS Barking and Dagenham was the first to threaten to terminate contracts of practices failing to meet tough targets, following concerns thrown up by an access-centred scorecard.

NHS Barking and Dagenham told Pulse it decided not to terminate contracts after the practices were able to demonstrate improvements, but warned: ‘We will do so if necessary.'

But GPs raised concerns that the bullying approach taken by some trusts could be in breach of the DH's new guidance offering NHS providers two chances to improve before their contracts are put under threat.

Dr Peter Graves, chief executive of Bedfordshire & Hertfordshire LMC, is planning to submit a motion to the LMCs conference condemning use of balanced scorecards, which he said had infuriated GPs locally.

He said: ‘They only include easily measurable criteria, ignoring large chunks of general practice. We're putting a motion to the LMCs conference to outlaw them.' The motion accuses PCTs of spreading ‘lies, damn lies and statistics'.

Dr George Moncrieff, a GP in Bicester, Oxfordshire, said it was essential GPs had confidence that any scoring system was properly validated before using it for disciplinary action.

Balanced scorecards are being used at 40% of trusts Trusts who plan to have a scorecard in place this year

NHS Bradford and Airedale
NHS Brighton
NHS Bromley
NHS Buckinghamshire
NHS Central and Eastern Cheshire
NHS City and Hackney
NHS Cornwall and Isles of Scilly
NHS Derby City
NHS Derbyshire County
NHS Devon
NHS Dorset
NHS Dudley
NHS Ealing
NHS Eastern and coastal Kent
NHS Haringey
NHS Hartlepool
NHS Havering
NHS Herefordshire
NHS Islington
NHS Lewisham
NHS Lincolnshire
NHS Middlesbrough
NHS Milton Keynes
NHS North Lancashire
NHS North Staffordshire
NHS North Tyne
NHS Oldham
NHS Peterborough
NHS Plymouth
NHS Portsmouth
NHS Redcar and Cleveland
NHS Richmond and Twickenham
NHS Somerset
NHS South Birmingham
NHS South Gloucestershire
NHS South Staffordshire
NHS Southampton
NHS Stockton on Tees
NHS Surrey
NHS Swindon
NHS Trafford
NHS West Essex
NHS West Kent
NHS West Sussex
NHS Wirral
NHS Worcestershire

Trusts which have imposed sanctions as a result of having balanced scorecards in place

NHS Barking and Dagenham
NHS Camden
NHS Greenwich
NHS Tower Hamlets
NHS Walsall

Trusts which have balanced scorecards in place

NHS Ashton, Leigh and Wigan
NHS Barking and Dagenham
NHS Berkshire West
NHS Blackburn
NHS Bolton
NHS Bouremouth
NHS Brent
NHS Cambridgshire
NHS Camden
NHS Coventry
NHS Doncaster
NHS East & North Herts
NHS East Riding of Yorkshire
NHS East Sussex
NHS Enfield
NHS Greenwich
NHS Hammersmith and Fulham
NHS Harrow
NHS Heywood, Middleton and Rochdale
NHS Hillingdon
NHS Hounslow
NHS Kensington and Chelsea
NHS Knowsley
NHS Lambeth
NHS Leeds
NHS Leicester
NHS Luton
NHS Newham
NHS North East Essex
NHS North Lincolnshire
NHS North Somerset
NHS Northamptonshire
NHS Oxfordshire
NHS Redbridge
NHS Sefton
NHS Sheffield
NHS South Tyneside
NHS South West Essex
NHS Suffolk
NHS Tower Hamlets
NHS Walsall
NHS Wandswoth
NHS Warrington
NHS West Herts
NHS Western Cheshire
NHS Westminster