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Anger at benefits move

GPs will be paid according to the number of mentally ill patients they help return to work under Government demands for changes to the quality framework.

Evidence from two departments to last year's review of the QOF called for new indicators to incentivise GPs for getting patients off incapacity


Although the indicators did not make it into this year's QOF, Department of Work and Pensions proposals to overhaul the incapacity benefit system, published this month, increase the pressure on negotiators to accept the change next time around.

The first indicator proposed by the Department of Health and DWP would see practices paid for identifying patients

offered one or more sicknotes for a duration of longer than

six weeks for a mental health problem.

GPs would then be paid for referring these patients to a 'rehabilitation adviser' under a second indicator.

An expert panel assessing submissions backed the introduction of the two indicators, concluding that returning to work had health benefits.

Dr Alan Cohen, director of primary care at the Sainsbury Centre for Mental Health, which also proposed the chan-ges, said the evidence of

an association between work-lessness and mental illness was strong.

He said: 'This is purely about the therapeutic benefits and impact of work on health outcomes and nothing to do with bureaucracy about whether GPs should be signing Med 3s.'

But the move will infuriate GPs, who have argued the doctor-patient relationship will be damaged if patients believe GPs are trying to force them back to work.

Dr Laurence Buckman, dep-uty chair of the GPC, said the GPC would continue to oppose the indicators and denied even seeing last year's submission.

He said: 'That's never something that's ever been anywhere near the QOF.'

The Welfare Reform Bill proposed extending the Pathways to Work scheme, which includes the rehabilitation advisers, nationwide by April 2008.

Dr Harry Yoxall, secretary of Somerset LMC which covered one of the pilot areas, said: 'I had a couple of patients who went through the programme and the end of the condition management programme was extremely positive.'

Indicators recommended last time which may make it next time around


• Weight management advice or referral to a specialist


• Review cancer cases to identify potential improvements in diagnosis


• rhinitis diagnosis

• inhaler technique

• personal action plans

Sexual health

• Agree referral pathways and record use of them

• In-house provision

of care


• Registers of patients

in care homes, with a history of fragility fractures and oral

steroid use

• targets for prescribing calcium, vitamin D3 and bone-sparing agents


• annual reviews

• recorded MRC dyspnoea scores

• Referral for pulmonary rehabilitation

• pharmacological treatment in accordance with NICE guidelines


• Tighter monitoring of antidepressant use

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