Primary care trust overview
All primary care trusts have been assessed on their performance during 2002 / 2003 against a limited number of key targets and a larger number and range of indicators. Key targets are the most significant factors in determining overall performance ratings this year. The ratings methodology for NHS primary care trusts is similar to that for acute trusts, but their indicators are grouped under unique headings reflect the responsibilities of these organisations in public health improvement, and as providers of primary care and commissioners of primary and secondary care services.
Key targets
- access to a GP
- access to a primary care professional
- number of inpatients waiting longer than the standard
- number of outpatients waiting longer than the standard
- total time in A&E
- single telephone access - implementation plans
- four week smoking quitters
- Improving Working Lives
- financial management
Performance against targets is assessed in terms of whether the target has been achieved, whether there has been some degree of underachievement or whether the target was significantly underachieved. Trust performance is considered to be of concern if there are:
- a sizeable number of targets with some degree of underachievement
- a smaller number of targets against which there have been significant levels of underachievement
- a combination of both
Indicators
The broader range of indicators make up a 'balanced scorecard' to refine the judgement on ratings. This balanced scorecard approach allows a broad range of areas to be measured within a single methodology. Trusts with high performance ratings therefore have to do well against a rounded set of indicators.
The indicators have been chosen to provide a balance across focus areas of access to quality services, improving health and service provision, outlined below:
Access to quality services
- emergency readmission to hospital following treatment for a fractured hip
- substance misuse: percentage of GP practices in a shared care scheme
- sexual health: access to services for early unintended pregnancy
- level of 24 hour access to specialist mental health services
- A&E emergency admission waits (12 hours)
- twelve month heart operation waits
- delayed transfers of care
- access to NHS dentistry
- PCT survey – access and waiting
- PCT survey – better information, more choice
- PCT survey – building closer relationships
- PCT survey – clean, comfortable, friendly place to be
- PCT survey – safe, high quality, coordinated care
- prescribing of atypical antipsychotics
Improving health
- death rates from circulatory diseases, aged under 75 (change in rate)
- death rates from accidents, all ages (change in rate)
- death rates from cancer, aged under 75 (change in rate)
- breast cancer screening
- cervical screening
- flu vaccinations
- teenage pregnancy: conceptions below age 18 (change in rate)
- diabetes services baseline assessment
- CHD audit
- suicide audit
Service provision
- emergency admissions (change in rate)
- emergency admission to hospital for children with lower respiratory tract (LRT) infections (change in rate)
- primary care management – acute conditions (change in rate)
- primary care management – chronic conditions (change in rate)
- community equipment
- patient complaints procedure
- prescribing of antibacterial drugs
- prescribing rates for drugs acting on benzodiazepine receptors
- staff opinion survey
- GP appraisal
- sickness absence rate
- fire, health & safety
- generic prescribing
For this year, clinical governance scores have not been incorporated into star ratings for primary care trusts, in recognition of their immaturity as organisations. CHI does intend to reflect clinical governance assessments in next year's star ratings.
Combined trusts
Trusts that provide services in more than one sector have been given more than one star rating. For instance a primary care trust that also provides mental health services will have a star rating in the primary care list and a star rating in the mental health list.
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