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Gold, incentives and meh

GPs set for enhanced service to refer patients for exercise and diet classes

Exclusive GPs in England are set to be offered incentives to set up a diabetes risk register and refer ‘at-risk’ patients for exercise and diet classes, under plans for enhanced services and QOF indicators drawn up by NHS chiefs.

The plans are laid out in a document seen by Pulse - which was sent to practices in areas piloting the NHS Diabetes Prevention Programme - outlining how NHS England wants to use the GP contract to support the introduction of the programme, which is currently being rolled out across the country.

The enhanced services are set to be implemented in the short term in pilot areas, and NICE has confirmed it will pilot the new QOF indicators in October 2016, with NHS England planning to include them in the 2017/18 contract.

The move comes after pilots for the scheme revealed low levels of uptake and retention of people on lifestyle change programmes.

NHS England said the GP incentives would improve adherence to NICE public health guidelines on diabetes prevention – on which the programme is based – and cut health inequalities.

However, GP leaders warned that incentives for primary care could end up wasting resources on a ‘tick box’ exercise for GPs, without established programmes to refer to.

The document - titled 'GMS contract proposals to support the introduction of the NHS Diabetes Prevention Programme’ - states: ‘In the long-term we will seek to develop QOF indicators to support and incentivise GP engagement with the NHS Diabetes Prevention Programme.’

It adds: ’In the short-term, as the availability of the behavioural interventions which will be procured… will not be universal, we propose to develop a locally enhanced service to support the programme’.

Under the proposals for locally enhanced services, NHS England says GPs would be required to:

  • Establish a risk register of people with ‘non-diabetic hyperglycaemia’;
  • Refer patients on the register onto an approved lifestyle-change/behavioural programme;
  • Recall patients on the register for annual checks.

NICE has said that it ’anticipates potential [QOF] indicators will be piloted in October 2016 – the final wording of the indicators is not yet confirmed’, while the contract proposal document says they will be introduced into the GP contract ‘from 2017/2018 onwards’.

But Dr Richard Vautrey, deputy chair of the GPC said: ‘The real challenge is not identifying people at risk but individuals then having the time and ability to engage in such a prolonged initiative that is often not convenient for them to access.

‘Producing yet more boxes to tick and be measured against won’t change that problem, which should be the priority to be addressed.’

Dr Kathryn Griffith, cardiovascular lead for NHS Vale of York CCG, said: ‘Although primary care can identify high-risk individuals… they need motivated patients and access to comprehensive programmes for lifestyle interventions

‘With so many CCGs in financial difficulty then I am not sure if the programmes are in place across the country. If they are not then financial incentives to refer people to poor services should be avoided.’

 

Readers' comments (17)

  • Please note that this is already my practice!

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  • GPs, or any doctor, should not have to 'refer' someone for an exercise scheme. This should be self referral. We need to reduce our workload, not increase it.

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  • 9:48 self-referring salaried doctor

    you've forgotten that they are all going to need a GANFYD letter saying that they are fit to do the exercise, indemnifying the gym and incriminating the doctor if and when one of them keels over

    must go, I'm buried under requests for letters for PIP appeals

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  • In 1995 I suffered a Cardiac Event.After extensive literature review I set-up a Cardiac club with three neighbouring practices.We introduced Sunday walks with help of walkers from Local council. Talks for from NHS dietician about meals. Partners were encouraged to attend the talks and cooking demonstration so that they can assist thier partners. Even agreed with Local sports centre to provide exercise sessions specifically tailored for Cardiac Patients.Every three months all members of the club were invited periodically at one surgery exchange their views about progress and get diagnostic test done.The club continued for 5 years then the local council withdrew support.However sunday walks continued for many years and members continued to walk regularly as they were provided with pedometer which were a novelty at that time and had be imported from Japan.Before the Surgery finally closed down in 2008 I did a quick analysis of the survivors.Ten patients out of original 13 members were still there on the list.This was a living proof if one need of the successful partnership between GP and patients.

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  • One of ours, housebound with morbid obesity, recently won his disability appeal and will now have even more money to spend on lardburgers. Completely insane.

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  • Better idea is to join the CCG and develop similar pilots and get pump priming . Then new pilots next year and raise your earnings to £210 per patient . Now set up a company grab any contracts as a locality lead and employ salaried gps while you suggest these brilliant ideas
    Plus £30000 k pa for nodding you head to more money

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  • Any patient who wants it to self refer.Make it readily available and easily accessible. Same with physio, psychological therapies and healthy eating/living advice. Should come no where near a GP surgery which is for illness and diseases (we are all seeing less of this and more drivel).

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