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Prescribing indicators included in PCT ratings overhaul

Published on 07/01/04 at 12:21pm

The  performance indicators used to calculate the star ratings of trusts in England have been given a major overhaul following protests about their relevance and accuracy.

Primary Care Trusts were rated alongside acute trusts, ambulance trusts and mental health trusts for the first time in 2003, but will be assessed by significantly different criteria this year

The Commission for Health Improvement (CHI) has re-drafted the indicators but will hand over responsibility for publishing the results to its successor body, the Commission for Healthcare Audit and Inspection, which comes into being in April 2004.

The overall total of performance indicators will be reduced by four to 42, with ten new indicators and only 19 unchanged for their next star rating to be published in the summer.

This contrasts with the ambulance trusts and mental health trusts which have seen the number of targets raised from 13 to 24 and 30 to 38 respectively. Acute trusts will have its targets reduced by just one to 44, with 31 of  them either altered or replaced with different indicators.

Across all the trusts there is an increase in indicators intended to reflect patient experience, including  for the first time the results of patient surveys carried out in ambulance and mental health trusts.

Four indicators related to prescribing in the 2003 assessment - prescribing rates of antibacterial drugs, prescribing of atypical antipsychotics, benzodiazepines and levels of generic prescribing. This year this has been cut to just two - the first will monitor prescribing rates for a so far unnamed number of 'selected drugs' while the second relates to prescribing for mental health.

The CHI document outlining the new indicators notes the 'selected drugs' indicator: "the primary care drugs bill continues to rise significantly every year. It is important that prescribing of medicines is both clinically and cost effective."

A spokesman for CHI confirmed that the prescribing assessment will be based at least in part on checking trusts' uptake of NICE guidelines. He added that CHI would not publish which drug prescriptions were being monitored at this stage in order not to influence the outcome.

Meanwhile the mental health prescribing indicator voices continuing concern about standards of service for these patients, with CHI pointing out that 90% of all mental health problems are dealt with in primary care, and 50% of patients with severe or enduring conditions treated in the community.

Along with cancer care, funding for mental health has frequently not reached its target in recent years, with DoH investigations finding the funds siphoned off to other parts of the service.

The CHI spokesman said it would be 'along the right lines' to conclude the dropping of targets relating to generic prescribing and benzodiazepine (one meant to rise, the other decrease) reflected confidence that most trusts had already met these targets.

"As more trusts meet the right standards it's appropriate to move on - the indicators are designed to show a range of performance and if everybody is meeting them, then they become less helpful," he said

CHI acting chief executive Jocelyn Cornwell said: "CHI has always been committed to improving the reliability and usefulness of star ratings and in strengthening the representation of patient experience. After talking to NHS organisations, and experts in this area we have been able to improve the robustness of some indicators, drop indicators for which the data are difficult to collect or that give unreliable information. This year we have also increased the number of indicators that reflect the patient experience."

But the NHS Alliance, which represents primary care trusts and their clinicians says that the indicators are a disappointment once again despite the changes.

NHS Alliance chairman Dr Michael Dixon said: "Rather than helping us to improve the NHS, systems like this encourage gaming and bureaucracy."

Dr Dixon added that the PCT targets were "more of the same" from 2003, and that they reflected levels of local deprivation and the performance of local hospitals rather than the contribution of PCTs.

The Alliance had sought to include greater insight into how well PCTs were re-designing services, engaging frontline clinicians and involving local people in decisions about services, but says these have again lost out.

"We have to stop measuring what is easy to measure and start thinking about what needs to be measured. PCTs themselves  - who include clinicians, managers and local people must be involved in that process. That is the only way we can make sure that everything we are doing is about improving the NHS, not employing more people to fill in more forms."

Forty-five PCTs in England gained the top three star rating in 2003, with  139 earning two stars, 98 awarded one star and 22 judged as failing to meet most standards with no stars awarded.

Related articles

NHS leaders pour scorn on star ratings

Friday, July 18, 2003

External links

Commission for Health Improvement NHS performance indicators 2003/4




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