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GPs go forth

GPC criticises 'misguided' plan for all-or-nothing diabetes QOF target

NICE’s proposal to introduce a ‘bundled’ QOF indicator in diabetes next year is ‘unnecessary and misguided’, the GPC has warned.

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, told Pulse the indicator - announced in a consultation document this week - would penalise GPs striving to do the best for their patients, particularly those working in the most deprived areas.

Dr Green said he would be responding on behalf of the GPC and would argue that the ‘all-or-nothing’ indicator would hit practices with large numbers of disadvantaged patients known to be difficult to reach for regular check-ups.

NICE put the indicator out for public consultation, with the aim of suggesting it for the 2015/16 QOF, along with another nine potential new indicators.

The bundled indicator would see GPs having to carry out eight annual process checks in each patient with diabetes in order to achieve any points, including three annual checks for which indicators were only recently removed from the QOF, namely weight, urinary albumin-to-creatinine ratio and serum creatinine/eGFR measurements.

NICE is currently piloting the indicator, which it developed following pressure from the Department of Health to come up with a QOF incentive that could address wide variation in completion of annual checks identified in the National Diabetes Audit (NDA), which suggested only half of patients receive all the checks every year in some areas.

Ministers backed the idea, despite a Government-commissioned review by RCGP revalidation lead Professor Nigel Sparrow concluding that disparities between QOF performance results and the NDA were due to differing coding and measurement methods.

In a statement to GPs about the new consultation, the GPC said it would be ‘keeping up the pressure’ to reduce bureaucracy in the QOF.

Dr Green told Pulse the proposed bundled indicator went against moves this year to reduce the ‘tick-box’ element of the framework.

He said: ‘The Government’s own report by Professor Sparrow showed that [the disparity with the NDA] was due to statistical differences, and they were looking at different populations. We don’t believe there is a problem to be solved and even if there were this would not be the way to solve it.’

He added: ‘To penalise practices for doing their best for their patients is quite wrong. Whatever the intention of this, the effect will be that practices will have less resource to deal with diabetic care - and the practices that will lose most will be those that have the most difficult-to-reach patients.’

The NICE consultation on the proposed diabetes indicator and other new indicators for 2015/2016 closes on Monday 3 February.

Readers' comments (6)

  • Simple way to fix this is remove free scripts if diabetics don't attend annual checks. Exemptions for disabled, for the rest it's their responsibility. Car owners do it so should diabetics. The Nhs doesn't cause diabetes...yet

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  • Although in my area we would cope better than others, I think the idea of this change is flawed. It requires the cooperation of patients, which means those practising in difficult environments, with language barriers and less cooperative patients will find this more difficult.

    It makes practices in richer areas more attractive so they will be able to attract the best GPs at the expense of those patients in poorer area.

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  • I'm commenting to express my disappointment in the response by jb Pittard to this article who seems to be implying that:

    (a) the reason these checks don't take place is totally down to a "non-compliant" patients
    and (b) a dx of diabetes is always down to something the patient did to cause the condition.

    As someone with type 1 diabetes I am pretty sure I caused this condition just as much as the NHS did. Last time I checked, type 2 diabetes can be down to lifestyle choices BUT it is not the only reason.

    I have no doubt that there are some hard to reach target groups and maybe this particular NICE proposal isn't the best way to tackle the problem.

    The proposal is an attempt to incentivise GPs to improve diabetes reviews and not to penalise them. If the proposal isn't right then please suggest an alternative model rather than showing your disdain to the target group you believe are responsible for poor attainment in diabetes QOF targets.

    Shouldn't GPs and patients be working together to try and improve care, rather than creating more barriers?

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  • This is not an incentive - this is purely about saving costs . Nhs can't afford to provide good care to the epidemic of diabetes ,
    If this was an incentive there would be extra funds.
    There is no extra funds being provided.
    Even the care processes are flawed.
    At present Qof pays about 40 pound per year per diabetic pts and that's only if the targets are met. It does not cover the cost of a nurse.
    What this will do is reduce the payment to possible 10 pounds per year per diabetic pt.

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  • "Simple way to fix this is remove free scripts if diabetics don't attend annual checks."

    So you'll coerce your patients in order to get QOF payments. Nice.

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  • i am absolutely disgusted at everyone who said free prescriptions should be withdrawn from diabetics who dont attend appointments.
    given that type 1's dont produce insulin, you are happy to withdraw insulin from them when they dont attend appointments & let them become so high with their blood sugars from your "dont attend GP appointment get no insulin state" who will then develop ketones which do kill
    the word Hilter springs to mind.
    type 1's are under the care of specialists at hospital as GP's dont have a clue about type 1 management & as we know hospitals do mess up & not send out letters with your appointment date.
    maybe if the govt invested money in research for diabetes & the cause & a treatment then you can pat yourself on the back as you'll of saved some money!!

    lets hope none of you ever have to have a love one or yourselves face the prospect of a life filled with type 1 diabetes.

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