GPs face tougher diabetes targets under new NICE QOF indicators
By Lilian Anekwe
GPs could face even tougher blood pressure targets in patients with diabetes if a package of new QOF indicators is included in the 2010/11 GP contract.
The first of the new indicators to be produced through the NICE-led process, which are up for inclusion in the QOF from 2010/11, are published today.
They include two potential new indicators for diabetes that will put pressure on GPs to drive down blood pressure in diabetes patients.
The NICE QOF advisory committee recommended that two new levels are introduced for the control of blood pressure in patients with diabetes.
One will set a target blood pressure of 150/90mmHg, and a second, lower target will drive blood pressure down to 140/80mmHg.
The suggested indicators will now be subject to negotiation by the GPC and NHS Employers, and those chosen will be included in the QOF from April next year.
Two existing clinical domains – learning disabilities and epilepsy – also have new suggested indicators, for measuring and recording thyroid-stimulating hormone in patients with learning disabilities, and for offering information on contraception, conception and pregnancy to women with epilepsy.
Dr Colin Hunter, a GP in Aberdeen, who chairs the NICE QOF advisory committee, told Pulse the committee had sought to bring the QOF in line with NICE guidance on type 2 diabetes, but had been forced into a concession because of the difficulties GPs might face treating patients to 140/80mmHg or lower.
‘The rationale relates to the NICE guidance for type 2 diabetes, which recommends a blood pressure target of 140/80mmHg.
‘But considering some of the evidence around how difficult blood pressure control was, there was a feeling that there was some merit in including a less difficult target.'
Dr Hunter added the group had been cautious in suggesting outcome-based measures be added to the QOF.
‘The epilepsy and learning difficulties indicators are process measures. The diabetes one is an outcome measure of sorts, but the Department of Health was not able to give us examples of good outcome measures in primary care so there are no new outcome indicators in that grouping.
‘There are no additional disease areas being put forward this year. I suspect a great many GPs will be doing this work already. Most GPs will be reasonably happy with them.'
Dr Martin Hadley-Brown, chair of the primary care diabetes society and a GP in Thetford, Norfolk, agreed GPs would find a target of 140/80 mm Hg ‘difficult to achieve'.
But he added:‘150/90 gives the impression it is an acceptable target, and it's not. I think that would actually be a retrograde step. 145/85 is reasonable as an audit and payment target.
‘Any target lower than 140/80 would be difficult to achieve and I'm particularly against any suggestion of introducing 150/90, because it gives a negative message. I would hope they leave the targets where they are.'
Professor Helen Lester, deputy director of the National Primary Care Research and Development Centre, will be running the piloting of a further set of new indicators in 30 practices from this October.
She said: ‘The new NICE-led process has created three indicators for negotiators to discuss this year.
‘These represent the tip of the iceberg in terms of the work that has been going on with NICE to prioritise a further series of potential new indicators that have already been through a consensus process with GPs and are now about to be piloted in 30 practices across the UK.'
‘This new system will ensure a series of high-quality indicators are produced on an annual basis that not only improve patient care, but that make sense to the profession.'