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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)

  • I dont want more work funded or not. Once again obesity is being seen as purely a medical condition. It is a society condition that public health should be addressing...ooops all the PH docs are being made redundant.

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  • Yet another initiative to address diet and exercise. Please, please will the powers that be look at the outcomes of previous initiatives. Our experience in Practice is that these extra initiatives make very little difference to the Health Promotion activity already undertaken by Practice Nursing. Nurse Practitioner/Manager with 26 years experience in Practice.

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  • Ha ha ha, to the same sort of lifestyle clinics public health in Brum closed down with no notice when social services ran out of money. So we find 'em and they get added to a list of identified unmet need. Sounds familiar.....

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  • Bob Hodges

    We're already doing this in effect.

    I'd happily take some money for doing it.

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  • The only way to tackle this is by showing 'soap' stars like Phil Mitchell, Ian Beale and others becoming fit and thin. Subtle marketing is the best for favourable outcomes. Once no one on television is fat or unfit the trend will spread rapidly.

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  • More money being thrown down the toilet of previously failed policies.

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  • Why oh why can't we invest in universal public health strategies or legislation. This is easily the most cost effective way of doing things.

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  • Follow the money. Presumably a large chain of gyms, or a clothing supplier for XXL tracksuits is lobbying HMGov to use GP's to find business for them, funded by the taypayer/council taxpayer. I've seen these schemes more times than I can remember and IT NEVER WORKS.
    1) first hurdle is no-one can find the right referral form
    2) the people who would benefit most don't want to do it, and the availble places are filled up with low risk pushy people
    3) The funding is withdrawn unexpectedly, but no-one is told

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  • Agree with all of above, these schemes never work. The epidemic of obesity needs a broad non-medical
    3 measure that would make a difference:

    1) 100% tax on all take away food-yes some takeaway outlets will go out of business-good there are too many.

    2) 100% tax on all sweets/biscuits/cakes/ chocolates and make all shops hide them in cabinets like they do have to do with cigarettes.

    3) Double the price of petrol/diesel. Yes food and goods prices will go up-good people will eat less and buy less crap they don't need. They will also drive less and buy less cars. A winner all around.

    If all of above implemented I guarantee the average waistline in this country will reduce dramatically.

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  • The visionaries who founded the NHS would weep bitter tears to see it founder over a surfeit of pizzas.

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