Health and Social Care Bill

My Lords, Amendment 185, tabled in my name and that of my noble friend Lord Patel, proposes that each clinical commissioning group must monitor the performance of primary care practitioners within its area and report its findings to the NHS Commissioning Board. The purpose of this amendment is to try to explore with Her Majesty’s Government their approach towards performance management and the assessment of outcomes in primary care. In hospital practice we are all obliged to subject ourselves to very careful performance assessment. There is careful collection of data on clinical outcomes, patient safety and patient experience. Indeed, with the adoption of service line reporting in many acute trusts, there is also meaningful information on the utilisation of resources to be able to determine whether those resources are being appropriately used to achieve the best clinical outcomes for our patients. The availability of the collection of these data and their reporting is having an important impact on transforming clinical care in the acute secondary sector. For instance, only this week the report on data analysed by the Dr Foster organisation has demonstrated that in certain acute trusts at weekends, where staffing levels are potentially not appropriate, particularly for senior clinical staff, the management of acute stroke, myocardial infarction and other acute emergencies is associated with a less good clinical outcome. To date, a similar approach to the collection of outcome data in primary care has not been achieved. As a result, it is not possible to speak with the same certainty about the performance of individual practitioners in primary care or indeed the performance and outcomes of primary care teams. This is a particularly important issue in the Bill. Rightly, the Bill recognises the importance of trying to change patterns and pathways of care to ensure that those with chronic conditions are more routinely managed in the primary care environment rather than being referred to the secondary care environment. However, if appropriate arrangements are not in place for the assessment of outcomes and performance in primary care, the transformation of clinical pathways of care to the primary care environment could result in a deterioration of standards and poorer outcomes for those patients because there will be no routine collection and reporting of the data on performance. It is argued that there will be certain measures and safeguards in place. For instance, all clinical practitioners will be subject to revalidation on a five-yearly basis. The regulator—in this case the General Medical Council—will have responsibility for that. However, as things stand, the responsible officers who will have the obligation of supervising the revalidation process for primary care practitioners are based in PCTs. I would be interested to know what arrangements have been made with regard to describing the role and establishing the function of responsible officers with regard to future clinical commissioning groups. Another issue is the current system of the quality outcomes framework and the additional points and therefore additional payments that can be achieved in primary care through meeting certain process measures that speak to quality in general practice. It is well recognised that the quality outcomes framework does not provide sufficient granularity to speak with the same confidence about the achievement of good clinical outcomes and the performance of primary care practitioners and groups. More needs to be done, potentially, with regard to the mandate that will be passed to the NHS Commissioning Board, and subsequently there must be instruction from the Commissioning Board to clinical commissioning groups on setting appropriate standards and ensuring that data are collected in a systematic and comprehensive fashion so as to be able to speak to performance in primary care. Is any work ongoing in the department with regard to the development of potential standards, and objective and validated outcome measures that might be applied by clinical commissioning groups to the management and measurement of performance in primary care? I would like to understand the view of Her Majesty's Government with regard to this area, how it might be developed going forward and if any thought has been given to how or whether clinical commissioning groups need to report back information on outcomes in primary care to the NHS Commissioning Board. This is an important issue because it will be the Commissioning Board that holds contracts for individual primary care practices. Perhaps I may remind the Minister of the interesting and informative report published by the King’s Fund in March this year, entitled Quality Improvement in General Practice, which at the time the noble Earl warmly welcomed. I note a quotation from the Health Service Journal in March 2011 in which the noble Earl said: "““Practices will be monitored, supported and held to account by the consortia””—" now the clinical commissioning groups— "““What GPs have to realise is they are going to be held to account in a new way””." How should noble Lords interpret that statement by the Minister with regard to the importance of assessing outcomes in primary care? I beg to move.