Published: 01/04/2004, Volume II4, No. 5899 Page 8

Up to seven trusts in Nottingham could lose a star in this year's performance ratings because efforts to reduce accident and emergency waiting targets came too late.

A major drive to encourage proper use of Nottingham's only A&E department at the Queen's Medical Centre means that 95 per cent of patients are now being dealt with in four hours, ahead of the current 90 per cent target and close to the ultimate December target of 98 per cent.

But this summer's star ratings will measure A&E performance from July 2003 to the end of last month. Consequently, Nottingham's emergency care network fears figures of 78 per cent in December, 84 per cent in January and 88 per cent in February mean two-star Queen's Medical Centre Nottingham University Hospital trust, three-star Nottingham City Hospital trust, and two-star East Midlands Ambulance Service trust could all lose stars.

A&E performance could also hit Nottingham City primary care trust, Erewash PCT, Broxtowe and Hucknall PCT and Gedling PCT, all of which have two-star ratings.

Nottingham City PCT chief executive Samantha Milbank, who also co-ordinates the city's emergency care network, fears that despite a 'huge effort' the acute and ambulance trusts could lose stars and financial incentives.

'You work harder and harder but you are not hitting the target despite all the work of staff, ' she said. 'With three stars you have extra money and freedom.

'One star gets you [media] attention.'

Ms Milbank said the area had examined the whole system when it decided to find ways of improving waiting times, from deciding who it was appropriate to see in A&E, to discharge procedures, internal processes and the role of the ambulance service.

In January, QMC introduced a new tough line on inappropriate use of A&E. For maximum effect the A&E was also renamed the Emergency Department.

The approach saw headlines in the local media saying the trust was turning patients away.

Ms Milbank says they were actually being redirected to the nearby minor injury walkin centre.

QMC and the PCTs are also carrying out a survey on the type of people who create highest levels of demand on acute services.

Ms Milbank said that despite the enormous improvement, she feared 'significant under-achievement' across the health economy could see all trusts in the area marked down.