Dr Phil Hammond, GP and broadcaster

Are star ratings good for patients? Health secretary John Reid claims they are, and that patients have a right to know how many stars their local trusts have got. But what patients probably don’t realise is how much pressure managers are under to deliver a top rating service.Take this story I heard recently.

Late one night a GP was called out to a patient in severe pain who had just been discharged straight home from the intensive care unit of a three star hospital. She had been admitted for routine orthopaedic surgery but crashed on the table; the operation was abandoned and she was sent to ITU.

She was in pain and her blood pressure was out of control, but there were no orthopaedic beds. So she was sent home still in pain, without all her medication as the hospital pharmacy was shut.

The GP was unable to contact the ITU consultant so sent the patient back in. Thus far, the unfortunate patient had jeopardised two targets – for cancelled operations and emergency readmission following discharge.

The patient was finally admitted to an orthopaedic bed, and sent home again on oral morphine after having her blood pressure monitored overnight.There was still no communication from the hospital, no follow up or plan or diagnosis of cause of pain or collapse, and she still didn’t have all her drugs.

GPs often get landed with this kind of situation. Alas, good communication between hospital and GP isn’t a star target, so it gets sidelined.

The ITU consultant later phoned to apologise about the initial discharge; they had to clear the ITU bed for an emergency and the orthopaedic and medical wards were full, so the patient was sent straight home.

The official line from the ITU is that treatment is now so good, many patients can be discharged straight home. But no one has discussed this policy with the local GPs, or provided the evidence to support it.

However, another reason could be that ITU can’t close to admissions when full because the cancelled surgery would lose the hospital a star. So, to free up beds, patients are discharged before they’re ready.

The Government may at last be getting the message about stars and targets. Ian Kennedy, chair of the Commission for Healthcare Audit and Inspection is known to favour subtler ‘intelligent information’ over simplistic hoop jumping. Kennedy describes the target culture as squeezing different bits of the toothpaste tube without improving the overall service.

But it’s hard to look at the new GP contract without thinking of performing seals. To get the money you need the points, and to get the points you have to tick all the right spreadsheets (or, more likely, be very nice to your nurses and ask them to do it).

It may all be based on the best possible evidence, but is it what patients really want? My guess is they’d far rather have more face to face contact and better communication between GPs and hospitals than quality points and star ratings.

Guidelines in Practice, March 2004, Volume 7(3)
© 2004 MGP Ltd
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