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Practices and PCTs must do more to be worldclass, says report

4 December 2007

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Though improvements have been made in healthcare services, there is still a way to go before everyone gets worldclass care, Professor Sir Ian Kennedy, chairman of the Healthcare Commission, has said today (Tuesday 4 December).

Sir Ian made the comments at the launch of the Commission’s independent report to parliament on the state of healthcare in England and Wales.

He said: “People are getting healthier, but there is serious disparity in both general health and in the care available to the haves and have-nots.

“Most organisations offer patients a good overall experience, but some lag behind. We need more attention on ensuring that patients get personalised care and fair access to services.

“Purchasing and providing primary care affects millions of patients, and all our work shows that it is not as good as it should be.”

He added: “We welcome Lord Darzi’s admirable vision of a worldclass health service for all. Our report on the state of healthcare sets out the progress made and the gaps that will need to be closed to make that vision a reality.”

The Commission makes six recommendations to the government and healthcare providers: improve the planning and commissioning of services; improve access outside the waiting time targets; promote a culture of safety more effectively; improve healthcare for children and young people; demonstrate more sensitivity to the needs of the individual; and use information better.

Key findings from the 2007 State of Healthcare Report include:

  • The health of the population is improving with significant increases in life expectancy, but there are major disparities around the country, particularly in poorer areas where there are often fewer GPs.
  • In poorer areas, where people tend to experience worse health, there are 18% fewer GPs than in the least deprived areas (54 per 100,000 people compared to 66).
  • Only 26% were “excellent” or “good” in 2006/7 compared to 33% in 2005/6. Many PCTs went through a reorganisation over the period, but this does not provide a complete explanation for the underperformance, says the Commission.

The Commission says PCTs form the bedrock of healthcare. They control more than three-quarters of the budget, purchasing services from other providers, including hospitals. They are directly responsible for providing services handling more than 80% of NHS contact with patients, including those carried out by GPs and dentists.

The report says that many PCTs do not fully understand the health needs of their local people, making it difficult for them to buy targeted services. For instance, last year 2.3 million people did not have their BMI index recorded as planned, with GPs not recording the data, which provides vital statistics on levels of obesity.

The report says 2,000 GP practices did not fulfil their PCTs’ plans to establish registers for those people at risk of coronary heart disease (CHD), designed to help prevent these patients from becoming seriously ill.

Responding to this report, Dr Laurence Buckman, Chairman of the BMA’s GP Committee said: “It may sound obvious but the GP’s job is to assess what is the best care for the person in front of them.  So if a person of a normal weight comes into their surgery it might not be appropriate or necessary at that time to record their height and weight to determine their BMI, particularly if they have come in with an entirely different problem.

“If someone looks overweight or underweight then GPs would usually record their BMI. The same is true for people who might be at risk of developing CHD – giving that person help and advice is far more important and useful than putting them on a register for the primary care organisation. That is what is of real benefit to patients in the long run.

“Blaming just GPs for fewer diagnoses of heart disease is unfair, as it is the responsibility of health professionals across the NHS to diagnose heart disease. The current scientific evidence also says that heart disease needs to be diagnosed with the use of an echocardiogram and that needs to be done in hospital.”

Healthcare Commission


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“It seems to me the important issue here will be defining the ‘benchmarks’ of what constitutes ‘worldclass’. If there are GP practices already offering ‘worldclass’ services then they should be made aware of this and used as the beacons for others to emulate. It is so easy to take a negative, pessimistic view of the majority when it may only be the minority affected. We need  facts and not feelings, and so often I find these are either not available or ‘spun’ for political reasons. Will this be another case in point?” – Peter Larmer, Manager, Suffolk