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Independents' Day

GPC agrees to the goalposts being moved

The GPC has been forced to agree to a swathe of new clinical indicators in the revised quality framework.

The new QOF will include seven extra clinical areas and 138 brand-new points ­ but no increase in overall number of points or money per point.NHS Employers said minimum thresholds would rise on all indicators and maximum thresholds on some ­ although Pulse understands that top thresholds will not change in the cornerstone areas of CHD and hypertension.

The agreement reassigns all 30 quality practice points, 80 on holistic care and others 'where it is no longer felt necessary to incentivise work'. Most of these 166 points are distributed among the new clinical areas ­ led by depression with 33 points, atrial fibrillation with 30, chronic kidney disease with 27 and dementia with 20 (see box, right).

The GPC has given only sketchy details of the new indicators, but Pulse has learned they will include screening all diabetes and CHD patients for depression, setting up registers for CKD, atrial fibrillation and obesity, and testing hypertensives for serum creatinine. GPs said the new indicators seemed sensible, but their addition contravened the principle of no new work without pay.

Dr Russell Thorpe, a GP in St Anne's, Lancashire, said: 'It goes against everything the new contract was supposed to be. The clear message is they feel they have overpaid us and want to rein it in, and make it harder for GPs.'

Dr Stephen McKenning, Isle of Wight, Portsmouth and South-East Hants LMC chair, said: 'The idea it is constantly reviewed makes a lot of sense, but there will be some who feel cheated that the goalposts have moved.'

But Dr James Gillgrass, chief executive of Surrey and Sussex LMCs, said: 'They got as good a deal as they could get. What one has to remember is that some work has been taken out.'

Some omissions from the new QOF were also controversial. CHD experts strongly criticised the failure to include points for cardiovascular registers, which they said were vital to pay GPs for implementing the new NICE appraisal expanding eligibility for statins.

Dr John Ashcroft, a GP in Derby and CHD lead for Erewash PCT, said: 'I'm very disappointed it's not in the QOF. It's very shortsighted. The NHS would actually save money and lives but they need to put the money into primary care to do this.'

What's new in revised QOF

  • Depression 33
  • Screening patients with diabetes and CHD, assessing severity of illness
  • Atrial fibrillation 30
  • Setting up register, confirming diagnosis, initiating and monitoring anticoagulation treatment
  • Chronic kidney disease 27
  • Setting up register, serum creatinine testing for hypertensives
  • Dementia 20
  • Setting up register, diagnosis confirmation, referral to specialists and treatment
  • Mental health 9
  • New indicators to be added to existing clinical area
  • Obesity 8
  • Setting up register
  • Palliative care 6
  • Setting up register
  • Learning disability 4
  • Setting up register
  • Ethnicity 1
  • Recording when registering

Sub-total 138

  • New points for areas QMAS shows harder to achieve 6
  • Existing indicator sets 22
  • Including summarisation of records, improving patient survey, follow-up action

Total 166

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