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A row has broken out over

local variations in the quality and outcomes framework after a PCT introduced a prescribing initiative that ignores targets in the contract.

The GPC accused the trust of 'rewriting the QOF' and urged GPs to ignore its 'amateur nonsense'.

North Eastern Derbyshire PCT had previously allowed GPs to exception report patients taking 40mg simvastatin for secondary prevention when they failed to hit the 5mmol/l cholesterol targets.

After reported intervention by the Department of Health, the trust has now set up a local initiative that rewards GPs without requiring them to hit the targets in the contract.

Under the scheme, GPs do not need to retest patients whose initial cholesterol was below 6.2mmol/l and are paid even when patients are not brought to target by 40mg simvastatin (see box).

The PCT insisted it had introduced the scheme to ensure GPs did not lose money by continuing to follow local prescribing policy that had been in place prior to the contract.

But GPC deputy chair Dr Laurence Buckman said: 'They are rewriting the QOF ­ you can't do that. I would strongly advise GPs in Derbyshire to stick to the QOF and not do some local piece of amateur nonsense.'

Dr John Grenville, secretary of Derbyshire LMC and a GP in Derby, admitted the scheme had been introduced because the department had 'not been happy' about the exception reporting policy.

But he said : 'If a PCT and GPs agree the evidence has moved on, then if GPs do not want to partake in the QOF it's voluntary. If the PCT wants to reward them for something else that's its prerogative.'

Dr Buckman questioned the 'academic rigour' of North Eastern Derbyshire PCT.

'The QOF was written by senior academics and based on Europe-wide evidence. Are we saying this PCT has greater expertise than the British Heart Foundation? I don't think Derbyshire is famed for its coronary expertise.'

The trust said a patient on 40mg of simvastatin would be counted under the local prescribing initiative or the quality framework but not both.

A spokeswoman said: 'The initiative was agreed to reflect the North Derbyshire statin policy. This policy was based on improved clinical outcomes with 40mg of simvastatin as per the Heart Protection Study.'

Prescribing initiative that 'rewrites QOF'

·GPs rewarded for 'appropriate' use of 40mg simvastatin for secondary prevention

·No need to retest cholesterol in patients whose initial level was below 6.2mmol/l

·GPs paid even if contract target of 5mmol/l is not hit and without having to try other statins

·A patient can be counted under local scheme or quality framework but not both

·Policy based on improved clinical outcomes in Heart Protection Study

By Nerys Hairon

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