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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 December 8; 335(7631): 1171.
PMCID: PMC2128678

GPs are struggling to gauge health needs of local people

Primary care trusts in England are failing to plan and purchase services that are appropriate to their local communities, says England’s healthcare watchdog.

In its fourth annual report on the state of health services the Healthcare Commission says that overall the quality of NHS services has improved in the last year, with 46% of trusts rated as excellent or good in 2006-7, up from 40% in 2005-6. But primary care trusts performed the worst for the second year running, with around three quarters (74%) rated as fair or weak for the quality of services they provide and 80% for the way they used their resources.

Anna Walker, chief executive of the commission, acknowledged that primary care trusts had been reorganised in the past year, but she was concerned that so many were “struggling” to meet the standards expected of them. Many trusts did not fully understand the needs of their local people, making it difficult to buy targeted services, the report says.

Last year GPs failed to record the body mass index of 2.3 million people, data that provide important statistics on the prevalence of obesity. The number of diagnoses of heart failure was also some 140 000 less than expected, suggesting that GPs are not picking up on signs of the illness, says the report.

Even where the needs of the community are known, trusts are not buying in the right services. Altogether 5000 fewer patients than planned had received emergency mental health care, because 41% of primary care trusts had not bought sufficient crisis services. Most trusts (85%) did not have arrangements for providing education programmes to patients with diabetes in their area. And 2000 practices did not fulfil their trust’s plans to establish registers for people at risk of coronary heart disease, a system designed to prevent serious outcomes in this population.

Despite overall improvements in the health services in England and Wales and better attention to safety, some significant gaps in the delivery of health care remain. Lack of data on sexual health had made it difficult to target people with the greatest need; and children’s services for the least well off families were not improving quickly enough.

The commission also raised concerns that although health overall was improving, the gap in health between rich and poor people remains unaltered, with men from more deprived areas living for a decade less than those in wealthier areas.

The report also said that although targets have helped reduce waiting times for hospital treatment, “hidden waits” in some services where waiting times are not measured are too long. It is not unusual for people in some areas to wait two years for psychological treatments or to have a hearing aid fitted, says the report.

Ian Kennedy, chairman of the commission, said, “We should be clear that there is still some way to go before everyone gets world class care. People are getting healthier, but there is serious disparity in both general health and in the care available to the haves and have nots.

“Most organisations offer patients a good overall experience, but some lag behind. We need more attention on ensuring that patients get personalised care and fair access to services. Purchasing and providing primary care affects millions of patients, and all our work shows that it is not as good as it should be.”

The report, which looks at health services provided by the NHS and the independent sector, found that overall 5% of independent service providers failed five or more of the government’s national minimum standards in 2006-7, a similar proportion to NHS trusts. Particularly worrying was the finding that 14% of mental health providers in the independent sector, which largely look after NHS patients, failed five or more of the standards.

The commission has called for a database to be set up to allow patients to see in one place the quality of care being provided by all NHS and private sector organisations.


State of Healthcare 2007 can be seen at

Articles from The BMJ are provided here courtesy of BMJ Publishing Group