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GPs face more CKD work for no pay

GPs will have to do extra work for no extra money under tweaks to the chronic kidney disease domain of the 2008/9 QOF.

Under changes revealed by the GPC, GPs must test all patients with CKD for proteinuria, as part of the process of deciding whether or not they should be treated with an ACE inhibitor or ARB.

The change was predicted by Pulse in October, but while it had been expected to carry extra QOF points, GPs will now have to conduct the tests for free.

But Professor Mike Kirby, professor of health and human sciences at the University of Hertfordshire and a GP in Radlett, said testing for proteinuria for all patients on the CKD register would be ‘worth the effort'.

‘If you want better care for your patients with diabetes or hypertension then you should be testing them for proteinuria to identify those at the highest risk. If you are going to do the job properly GPs should be testing all patients with CKD.

‘This is firm evidence-based territory and it is good to align the QOF with NICE because it can then be a consistent message. It is so important to detect proteinuria and it will be worth the effort.'

The QOF will also include a new indicator incentivising the creation of a register of all COPD patients with a diagnosis confirmed by post-bronchodilator spirometry.

Dr Steve Holmes, chair of the General Practice Airways Group, said the new indicator would make diagnosis of COPD simpler for GPs.

An atrial fibrillation indicator has also been amended, meaning GPs will now have to confirm all new diagnoses of atrial fibrillation with ECG or confirmation by a specialist within three months of diagnosis.

Indicators on stroke, diabetes, palliative care, and smoking have all been tweaked to ensure the QOF ‘stays in line with new clinical evidence and the evolving nature and work of general practice'.

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