Gaps in GP services 'very stark'

Gaps were identified in GP services

GPs are not doing enough to prevent ill-health by failing to diagnose patients and not collecting all the appropriate data, a watchdog says.

The Healthcare Commission also said GP care was likely to be worse in deprived areas and called for the "very stark" issue to be investigated.

But the annual State of Healthcare report found overall care was improving in England.

The government said it was looking to address problems with GP services.

The watchdog found family doctors had measured the body mass index - used to identify obesity - of 12.5m patients - but this was over 2m less than planned.

I do not know what it is that leads to GPs not doing this basic work. It is just very stark it is not happening Anna Walker, of the Healthcare Commission

Many doctors were also failing to record whether their patients smoked.

And GPs in over half of the 152 health areas were failing to produce up-to-date registers of patients with chronic conditions.

The watchdog said these were essential in helping to prevent people with conditions such as heart disease, diabetes and asthma ending up in hospital.

And the report said GPs may be missing signs of serious illness as patients diagnosed with heart failure was 140,000 less than expected.

What is more, the report suggested care was worse in the most deprived areas, which had 18% fewer GPs per head than more affluent places.

An analysis of GP performance data showed that scores on the management of blood pressure and cholesterol tended to be worse in poorer areas.

Healthcare Commission chief executive Anna Walker said: "I do not know what it is that leads to GPs not doing this basic work. It is just very stark it is not happening."

She also conceded this could have been one of the causes of the worsening performance of primary care trusts, which are responsible for local services.

A quarter of PCTs were rated as excellent or good last year, compared to a third the year before.

'Dramatic'

Nonetheless, the watchdog said the NHS was improving the quality of care it provided with falls in waiting particularly "dramatic".

The report said nine in 10 of the 80,000 hospital patients surveyed were happy with their care, although there were concerns about the respect given to patients and the help they received with eating.

Questions were also raised about private providers of NHS care - about a tenth of all non-emergency operations are done by the private sector.

To tackle health inequalities and improve convenience we will increase the number of GPs in disadvantaged areas and set up new health clinics that are open seven days a week Health Secretary Alan Johnson

The report said the most common areas of non-compliance against core standards were related to the monitoring of treatment, training and recruitment of staff and taking patients' views into account.

Mental health services were also highlighted as an area needing improvement with long waits for psychological therapies, the use of mixed-sex wards and lack of crisis teams continuing problems.

Health Secretary Alan Johnson said the report showed patients were "waiting less time, getting faster diagnosis and better treatment".

But he added the government was aware some areas needed addressing, including GP care.

"To tackle health inequalities and improve convenience we will increase the number of GPs in disadvantaged areas and set up new health clinics that are open seven days a week."

But Lib Dem health spokesman Norman Lamb said: "As an NHS report card, the conclusion is could and must do a lot better."

Dr Laurence Buckman, chairman of the British Medical Association's GPs committee, said: "It may sound obvious but the GPs' job is to assess what is the best care for the person in front of them.

"So if a person of a normal weight comes into their surgery it might not be appropriate or necessary at that time to record their height and weight to determine their BMI, particularly if they have come in with an entirely different problem."

And he said hospitals have more of a role in diagnosing heart problems.