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Crackdown on GPs over heart failure

NHS managers are demanding that quality framework indicators that are easy for GPs to hit are removed and included in their core work.

Their place in the framework would be taken by new clinical domains and indicators, expected to include obesity and tougher mental health standards.

The move, to be discussed by contract negotiators in a review of the framework this year, could mean practices facing a drop in quality pay.

GPs would also face more work to set up disease registers and hit the new targets.

Chris Town, head of the NHS Employers' negotiating team, said he would be looking for 'efficiency savings' in a new framework to start from April 2006. He said: 'We're looking at the margins. If we were to put more money in, what would we get for it?'

The news emerged after Pulse revealed GPs would average between 920 and 950 quality points this year.

PCTs have only been give enough cash to pay for 777 points this year and are also expected to be more than £100 million short in 2006.

GPs said there should not be wholesale change to the framework and called for a period of 'consolidation'. They added that new indicators should only go in if they were evidence based and extra cash would have to be added to global sums to cover markers moved into essential services.

Dr Ian Hume, chair of Norfolk LMC, said major changes would be 'totally unsatisfactory'. He said: 'I'm not impressed by that at all. I think that goes completely against the spirit of the agreement.'

Professor Martin Roland, director of the National Primary Care Research and Development Centre and an author of the quality framework, said new indicators had to be 'relevant to what GPs do'.

He said: 'GPs will not be looking for big change. The administration for them has been considerable.'

The Government has already signalled that it wants new indicators relating to public health in the framework.

GPC negotiators refused to speculate about the review.

But former GPC deputy chair Dr Simon Fradd said income GPs earned from the 'easy' quality indicators would have to be put in practices' global sum. 'It really depends on resourcing. In a way it could be useful for maintaining 1,050 points and bringing new indicators into the Q&O.'

'Easy' areas under the spotlight

·Target HbA1c <10: diabetes="" indicator="" 7="" (11="">

·Lithium therapy monitoring: mental health indicators 3-5 (11 points)

·Severe mental health review: mental health

indicator 2 (23 points)

·Epilepsy clinical domain (16 points)

·Hypothyroidism clinical domain (8 points)

By Rob Finch

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