Proposals to sack NHS managers if they fail to perform in league tables have been criticised by DAUK’s GP committee.
The committee said it was ‘somewhat surprised’ a package of reforms announced by Health Secretary Wes Streeting – including the introduction of NHS league tables – failed to mention the role of general practice.
Under the reforms, a review will be carried out of NHS performance across the country, with providers placed into a league table.
Persistently failing managers will be replaced and turn around teams deployed to help providers which are running big deficits or poor services for patients. They will be offered urgent, effective support to improve their service.
General practice
Dr Ellen Welch, DAUK vice chair, said Mr Streeting’s speech to the NHS Providers conference made no mention of GPs. This was ‘despite Lord Darzi’s report advising him to invest in general practice’.
She said: “In England, the number of medical staff working in hospitals has increased by thousands while general practices have closed in their hundreds, and the primary care workforce is shrinking with almost 2,000 fewer GPs than we had in 2015.
“Despite this, an average of 1.4 million GP appointments per working day were delivered between March 2023 and February 2024.
“Mr Streeting is looking for better value for money. General practice is already providing remarkable value for money and with proper funding can provide even more.”
Dr Lizzie Toberty, DAUK’s GP lead, warned the proposals may demoralise staff.
She said: “I broadly support more accountability for managers.
“Helping struggling trusts rather than demonising them is vital to reducing the toxic culture which exists in so many.
NHS league tables
“However, when did league tables in health or education ever improve care? They solve nothing. In the worst cases they will demoralise staff and encourage manipulation of the figures.
“The announcement is massively avoiding the elephant in the room, namely National Insurance contributions which are about to collapse general practice.”
Dr Welch echoed Dr Toberty’s concern league tables would hit morale.
She said: “Introducing league tables sounds like a sure fire way to demoralise hard working staff even further.
“No one goes to work in the NHS to do a bad job. I worry these plans are going to create more problems for trusts that are already struggling.”
Postcode lottery
Dr Sarah Jacques, DAUK GP committee member, said many factors might contribute to underperformance.
She said: “A rewards system feels like a postcode lottery with the ones doing well getting more funding and the ones doing badly getting funding cut – and then getting worse.
“Tertiary centres may end up with worse outcomes due to more complex cases with higher risk.
“There are too many factors that can’t be directly compared. Different demographics, poverty levels, functioning versus non-functioning local authorities.
“League tables oversimplify it all.”
Dr Rosie Shire, DAUK GP committee member, added: “We already have Care Quality Commission (CQC) ranking hospitals in a similar way to Ofsted. I don’t think that has helped improve things.
“How will league tables show anything different to CQC ranking? And how will it all impact upon the mental health of staff?”
GP investment
Dr Steve Taylor, DAUK GP committee member, said he was ‘somewhat surprised’ Mr Streeting failed to mention GPs in his speech today.
He said: “By the end of today 1.4million people will have consulted in general practice and half the population by the end of the month.
“A continued focus on secondary care fails to address the problem, that with just 5.6 per cent of the NHS budget going to GP practices, they cannot provide the services needed to prevent illness, support patients in their homes and provide care closer to home.
“Proper general practice investment will fix the NHS and improve care for patients.”
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