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GPs fine hospitals over failure to meet A&E waiting time targets

Exclusive: Clinical commissioning groups have begun imposing fines on hospitals that are failing to meet A&E waiting time targets, in a sign of the growing willingness of GP commissioners to tackle underperforming acute trusts.

Three CCGs in Worcestershire, who have been handed delegated powers from the PCT, have withheld a total of £1.2m in payments to Worcestershire Acute Hospitals NHS Trust over the last three months.

And in Northamptonshire, two CCGs, Nene Commissioning and Corby Healthcare, plan to withhold up to £56,000 from Kettering General Hospital – equating to 10% of their monthly funding - after it failed to meet operational targets in every quarter in the past year.

The Government stopped publishing quarterly data on A&E waiting times last month (see box below). But hospital trusts are still required to ensure 95% of patients are seen within four hours as an operational target.

A spokesman for NHS Worcestershire said South Worcestershire, Wyre Forest, and Redditch and Bromsgrove CCGs had steered the process of issuing a performance notice and withholding 2% of payments after A&E services were delegated to GP commissioners last year. 

‘Fines have been imposed for November, December and January - three fines of £400,000,' he said. ‘However … so long as the trust continues to put in place a number of improved actions, these fines will be reinvested in the acute trust to help improve frontline emergency care.'

Chris Tidman, director of finance for Worcestershire Acute Hospitals NHS Trust said: ‘While the PCT continue to retain the focus on A&E performance and are exercising their right to fine, they are also supporting the Trust with a number of investments to improve services.'

Meanwhile in Northamptonshire, GPs at the Nene Commissioning and Corby Healthcare CCG have stepped in after the proportion of patients seen within four hours fell to 92.3% last month.

A spokesman said: ‘Whilst actions plans have been put in place to improve A&E performance, these have not realised the changes anticipated.'

‘We therefore have no choice but to serve an exception notice on the trust in relation to this performance, which will result in us withholding an element of contract funding from them for this financial year.'

Lorene Read, chief executive of Kettering General Hospital, admitted that ‘achieving the 95% target has been very challenging this year' but said progress had been ‘encouraging'.

Dr Charles Alessi, NAPC chair, and a GP in Kingston-upon-Thames, Surrey, said he hoped CCGs would eventually be able to move beyond punitive measures. ‘We have an opportunity to really involve hospitals. Yes, we have to hold people to account - but it should never get to that stage.'

Dr Agnelo Fernandes, the RCGP's urgent care lead and chair of Croydon Healthcare Consortium, said: ‘A provider should not expect to be paid for something they haven't delivered. This is not new, but GPs have brought a new dimension into this discussion, by placing quality and safety at the top of the agenda. If you look at those first, the finances follow.'


How A&E performance has slipped

- A&E waiting times have been an issue since the coalition abolished the Labour target for 98% of patients to be seen within four hours

- The four-hour target was replaced in the Operating Framework in April 2011 by a set of clinical quality indicators – it was however retained as an operational target, but at 95%.

- Since then, performance against the target has slipped. In July-September 2011, the last recorded quarter, 95.90% of patients were seen within four hours, down from 97.02% year-on-year.