BRITISH DOCTORS NOW TO BE REWARDED FOR BEING GOOD BULL-ARTISTS

Every doctors' surgery is to be inspected and awarded Michelin-style stars so that patients can tell the quality of care offered by their GP at a glance, The Times has learnt. Expert panels will give family doctors one of three gradings in a move backed by ministers desperate to show that patients are getting value for money from huge GP pay rises. The scheme, being drawn up by the Royal College of General Practitioners, will run alongside government plans to publish detailed patient surveys of each surgery's performance.

Ministers want to increase the pressure on GPs to perform after salary rises last year took average annual pay to 94,000 pounds. Critics believe that the GP contract was bungled and won too little in return for the NHS. The new GP ratings will be reviewed - with the possibility of upgrade or demotion - every three years after a two-day assessment by a panel including a doctor, nurse, surgery manager and patient representative, The Times understands. Britain's 10,500 GPs will be encouraged to display their rating on a plaque outside their surgery and also on letterheads. Practices that repeatedly fail to achieve the basic level can expect to be replaced.

The scheme should be in place by next April. Around 2,000 surgeries have so far signed up to a forerunner scheme called practice accreditation. Mayur Lakhani, chairman of the college, said that the rating system would improve standards and make the system more "customer-focused".

Dr Lakhani, who is also visiting professor in the Department of Health Sciences at the University of Leicester, said that it would provide patients with a clear indication of qua-lity, not dissimilar to the Corgi rating given to plumbers. It will apply to all providers and help patients to choose between the growing number of private health firms looking to move into the family doctor sector. "This would be the most important advance in general practice in a generation," Dr Lakhani said. "At the moment we don't really know what the accreditation is, what it represents. As a result you get a small number of practices that aren't up to scratch and we have no mechanism, no handle, on how to get things to improve."

The minimum standard - a Level 1 rating - will require GPs to pass a wide range of assessments. These include opening hours, prompt telephone answering and flexible booking to fit in with patients' busy lives as well as the standard of facilities and quality of care from doctors and nurses. Levels 2 and 3 will be judged on similar but higher standards, with the top grade requiring extra measures such as research into patient needs and greater responsiveness to community needs.

The Times can also reveal that six million patients will be asked to assess their GPs over the next year after complaints about problems in booking appointments embarrassed Tony Blair on live television during the general election. Anonymous results will appear on primary care trusts' websites so that the public can compare surgeries. Sources at the Department of Health confirmed that Patricia Hewitt, the Health Secretary, strongly supported the ratings as a way to regulate general practice and inform patients better.

The drive for more information was given extra impetus when Mr Blair admitted during the election that he was "astonished" after an audience member said that she could not book a GP appointment. Surgeries were refusing to book ahead so that they met government targets to see everyone within 48 hours of an appointment being made.

Dr Lakhani added that failure to reach Level 1 would put the surgery at risk of being dropped by the local primary care trust. He said that GPs would require considerable support to assist with regulation and reform, which the college would help to provide. He will outline the broader changes to the profession in a conference speech this week.

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Public hospital negligence in Victoria, Australia

A top Victorian surgeon has blamed communication and system failures at the Royal Children's Hospital for a medical disaster that left a baby brain-damaged. Prof Paddy Dewan told a medical inquiry yesterday he was astounded not only that a toxic glucose dose was put in the boy's drip, but also that the treatment continued unchecked. The pediatric surgeon labelled the child's case an "unbelievable scenario" compounded by an overlap of medical and surgical unit care.

The Medical Practitioners' Board of Victoria is investigating unprofessional conduct claims against three doctors in the wake of the tragedy. Dr Lea Lee Foo, Dr Shobha Iyer and Dr David Tickell face potential penalties ranging from counselling to deregistration if found guilty. Dr Foo is accused of ordering the wrong intravenous drip fluid solution. The two others are accused of failing to properly examine the child and check his fluid treatment. The doctors deny being unprofessional.

The disciplinary hearing has been told the baby, who cannot be identified, suffered permanent brain damage after he was given a glucose solution 10 times stronger than advised. The boy was admitted suffering vomiting and was diagnosed with an abdominal problem that needed routine surgery. The drip was inserted in the early hours of September 19, 2001.

Prof Dewan said he had discussed the baby's condition and treatment with the boy's father, Dr Foo, registrar Dr Gehan Roberts and at least one nurse for up to an hour. It was agreed 50 per cent glucose would be added to an intravenous drip mix to make up a 5 per cent solution. Instead, the baby was given a 50 per cent glucose concentration. "To give an infusion of 50 per cent dextrose is a toxic solution and that was not the order that I gave," Prof Dewan said. He believed the registrar clearly understood the instruction, but conceded the junior doctor may have been confused.

Asked about a program the hospital had brought in to encourage staff to speak up about concerns, Prof Dewan replied: "Junior staff and nurses are not going to speak up if they see a professor getting fired for doing so." The hospital sacked Prof Dewan three years ago after the board decided his relationship with surgeons had deteriorated beyond repair. Before his sacking, he aired allegations about patient safety risks.

Nurse Jayne Morrison told yesterday's inquiry she held up a piece of paper to Dr Foo to confirm it was the right order, but did not discuss it.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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