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GPs in tough fight for CHD quality pay

GPs face a much tougher task than they realise to earn CHD quality pay under the new contract.

A major study of 14,500 CHD patients has revealed only half of those on statins are achieving the 5mmol/l chol-esterol target in the quality framework. Even after GPs switched to stronger statins or increased the dose, 43 per cent still failed to hit the target.

The findings have prompted warnings that practice prescribing budgets will go into orbit as GPs struggle to get 60 per cent of their CHD patients below the target. This will earn the average three-partner practice £1,200 in 2004/5 and £1,920 the following year.

The researchers, who presented their findings to the Primary Care Cardiovascular Society conference in Dublin, also found 80 per cent of 221 GPs they questioned thought they were doing enough to meet cholesterol targets.

Study leader Dr Adrian Brady, consultant cardiologist at Glasgow Royal Infirmary, said this was 'a long way from the truth'.

Dr Ahmet Fuat, a GP in Darlington and a research fellow at the University of Durham, said GPs would be forced to switch to more expensive statins. 'The option to prescribe high-performance statins will be essential,' he said.

Dr Peter Graham, GP prescribing lead at East Highlands local health care co-operative, said some practices already had £300,000 overspends and there was an 'enormous tension' between prescribing budgets and quality targets. 'More money is going to have to come from central Government.'

But the Department of Health said no new money would be available: 'PCTs have a statutory responsibility to break even, and in so doing manage all their budgets, including prescribing.'

GPC negotiator Dr Laurence Buckman said GPs could use exemption reporting as a loophole to help them meet quality pay targets. 'If a patient is on the maximum dose of a statin and still isn't meeting the target, that is an exemption.'

Prescribing overspends soar

Dr Mark Lawton's three-partner practice in Coventry has run up a £100,000 prescribing overspend in its bid to get CHD patients down to target cholesterol levels.

'It has been an arduous task,' said Dr Lawton. 'We're always playing catch-up with drug budgets. But if we're going to treat to target we've got to prescribe the expensive drugs.'

Dr Lisa Silver's three-partner practice in Nettlebed, Oxfordshire, started putting all at-risk patients on statins two years ago. Its £400,000 prescribing budget is now £90,000 overspent.

Dr Silver, a member of the new contract implementation group for South East and South West Oxon PCTs, said: 'Our statin prescribing rose 22-fold. Statins now occupy 25 per cent of our entire spend.'

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