Agenda item

David Riley, Head of Primary Care Improvement with Leicester City Primary Care Trust, submits a paper updating the Committee on the introduction of a Balanced Scorecard and the progress made so far in the Annual Quality Review programme, together with key themes, areas of learning and next steps in this annual cycle.  The Committee is recommended to consider this report and comment as appropriate.

David Riley, Head of Primary Care Improvement with Leicester City Primary Care Trust (PCT), submitted a paper updating the Committee on the introduction of a Balanced Scorecard and the progress made so far in the Annual Quality Review programme, together with key themes, areas of learning and the next steps in this annual cycle. 

David Riley drew particular attention to the following:-

·              One element of the annual cycle of quality was the production of annual quality plans for general practice.  This, and the Balanced Scorecard, were benchmarking practices;

·              An example of a populated Balanced Scorecard was tabled at the meeting and is attached at the end of these minutes for information.  It was hoped that this would eventually be updated monthly.  The possibility of automating the Scorecard was being investigated.;

·              A national Patient Experience Survey had been undertaken, to which 16,000 responses had been received.  These results were taken very seriously and, when put with other data, such as that from the census, gave a clearer picture of the City;

·              Each GP practice was now part of the programme of annual review visits.  To date, 59 had been visited and a further 4 would be visited before mid-April 2010.  Each practice had specific areas that needed to be developed.  When GPs had more than one practice, each was treated as a separate practice and visited accordingly;

·              Leicester City PCT was very poor in terms of patient satisfaction, but the introduction of these measures meant that GPs could now see how each practice was rated;

·              As well as benchmarking, a “traffic light” system of rating also was used.  The PCT worked very closely with practices receiving a red rating to improve service quality.  However, if improvements could not be made, contractual remedies would have to be considered, such as the issue of notices to improve;

·              The information gathered through the Annual Quality Review programme was considered by a Quarterly Review Team, which comprised of high-level officers and contractor input.  The results of the review were fed to the practice concerned and the Balanced Scorecards became part of the that practice’s quarterly review plans;

·              The results of the review also would be made available soon to the general public, for example when looking to change GP practice.  At present, discussions were being held on whether it should be included on the national promoting NHS choices website and, if so, how it should be presented; and

·              The results obtained from these reviews needed to be matched to other data, for example the number of complaints received about a practice.

During discussion on this, the Committee noted that other PCTs did not appear to be publishing data on quality of GP services.  David Riley explained that practices were being categorised, so that differences in quality between apparently similar practices could be seen, (for example, as shown through comparing satisfaction surveys).  Tim Rideout, Chief Executive of Leicester City PCT, undertook to give further consideration to the publication of this data, as one way of helping people to choose which GP surgery to register with.

The Committee was reminded that work had been undertaken to see if there were identifiable reasons why there was poor uptake in different GP practices.  However, there appeared to be no correlation between practice coverage and ethnicity or deprivation.  (Minute 28, “Smear Testing and the Detection of Cervical Cancer”, 22 October 2009 referred.)

The Committee questioned whether GP practices were happy with the results of the assessments undertaken and was advised that, at present, the data was still being summarised.  Further discussions on the next steps in the process would be held in mid-April 2010.  It was emphasised that this work was part of the PCT’s quality improvement agenda and did not form part of the GP’s contracts.  Although the PCT had stated at the start of the process that it would use contractual sanctions if there was sufficient cause for concern, to date this had not been necessary. 

Members asked if it was likely that people would want to register with GP practices already seen as good and not take in to account that other surgeries could be improving.  Tim Rideout explained that this did not appear to happen.  Poor GPs often were well liked by patients, as they often routinely prescribed medicines and referred patients to hospital.

Tim Rideout further explained that this work was part of a coherent strategy that included:-

·              improving capacity – including the provision of new general practices for the City, at which a lot of people were registering.  This movement was being encouraged, as it was easing the pressure on other practices;

·              premises – a lot of work had been done to improve these, but a lot more still needed doing; and

·              funding – when the PCT looked at funding, as requested by the Leicester City Council Health Scrutiny Committee, it was found that funding had no correlation to patient care.  As a result, Leicester became one of the first areas in the country to redistribute funding.

This gave an unequivocal base line against which GP practices could be held to account in the long-term.  The first round in the current quality review programme therefore gave “alerts” to practices about what was expected from them, but improvements would be expected in the next round, so that the City could improve what was recognised as its poor position of 140th of out 150 PCTs in terms of quality of service.

Zuffar Haq, Co-Chairman of the Leicester City Local Involvement Network, queried whether this work was being undertaken in response to a need to reduce the number of people attending hospital Accident and Emergency departments, due to cuts in funding.  Tim Rideout explained that, although the numbers attending Accident and Emergency departments needed to be reduced, Leicester City PCT had provided the department with more funding than just the national settlement, in order to help it make changes.

Some concern was expressed that communication was a problem in Leicester, with some communities, especially newly arrived ones, not understanding the system.  Tim Rideout explained that the large transient population in the City presented problems, but a lot of work had been done to ensure that all communities were aware of the system.  This included having community-level workers to explain how best to access services and to work with GP practices in the areas of the City concerned.  However, it was recognised that more could be done to explain processes.

The Committee identified some confusion over treatment that could be provided to people who had been refused permission to stay in the country.  People in this situation could not register with a GP, but this could create problems if these people had communicable diseases.  In reply, Tim Rideout explained that the PCT ran some practices exclusively for asylum seekers and those refused leave to remain in the country.  Accident and Emergency departments never turned anyone away, so they could receive treatment there, but the patient would be billed for any on-going treatment and the hospital would seek reimbursement.  An exception to this was genito-urinary care, to which there was completely open access.

Members suggested that the PCT could make more use of elected Members.  For example, some communities were at greater risk of certain health problems than others, so Members could use their networks in those communities to help share information.  Tim Rideout concurred with this, explaining that the PCT currently used Ward Community Meetings as one way of reaching communities.  David Riley advised that, in addition, each practice was being asked to establish a patient participation group.

David Riley suggested that:-

·              the Balanced Scorecard could in future contain data about whether visits by GPs to people’s homes were available, (see minute 64, “Leicester Local Involvement Network (LINk)”, above); and

·              it would be useful if links could be made in the Balanced Scorecard with the Leicester City Local Involvement Network.