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.’
The diabetes programme
The NHS Diabetes Prevention Programme was launched last year with plans for GPs to screen millions of people in order to identify those at high risk of type 2 diabetes and refer them for exercise and cookery classes.
NHS England says there are as many as five million people ‘on the cusp’ of diabetes and that its prevention programme has the scope to cut the proportion of those going on to develop full-blown diabetes by as much as 30-60%.
After a year of piloting, the programme got underway in earnest last April, with plans to recruit 20,000 ‘at-risk’ people onto lifestyle change programmes over the coming year. However, emerging results from the pilots revealed challenges with recruitment, with only a fifth of those identified as high risk taking part in the scheme in one area.