PERFORMANCE: A groundbreaking project monitoring the quality of GPs faces an uncertain future once its host strategic health authority is abolished.

NHS London has admitted that its scheme, which tracks individual practice performance against 22 different indicators, could be scrapped if a home is not found for it.

The system has been two years in development. Howard Freeman, associate medical director of primary care at NHS London, admitted it was “not absolutely clear” what would happen to it.

Dr Freeman told HSJ: “Our aspiration is that this system, which has huge potential to reduce variation in primary care, will be incorporated into the new [structure]. This means making information about health as transparent as possible while providing all GPs with an invaluable tool to learn from their peers.”

He hoped the London programme would “contribute learning” to the Department of Health’s national primary medical care contract management framework, which is expected soon.

The London system grades the capital’s 1,500 practices into four quality categories – “higher achieving London practice”, “achieving London practice”, “approaching review” and “review identified”.

The figures indicate that roughly 10 per cent of London’s practices are in the top category, while a similar proportion are in the lowest “review identified” category.

Dr Freeman said this was a standard bell-curve distribution of results, and that they were not weighted for population need.

He gave the example of Richmond and Wandsworth, neighbouring boroughs in the south west London cluster, in which the latter has five times the patient list turnover as the former.

Dr Freeman stressed that the grading system would be used to ask questions of practices with poor scores, but said lower scores did not necessarily indicate a poor practice.

Twenty of the indicators mainly concern aspects of care quality or access.

Two illustrate a practice’s relationship to the wider health economy. These indicators often show how often patients with a long term condition are admitted to hospital in an emergency and how often patients from this practice go to accident and emergency.

NHS London plans on introducing six more outcome measures by September.