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GPs of all races face nonsense GMC complaints

Department wants to bring QOF in line with tougher NICE guidelines, says the diabetes tsar ­ Daniel Cressey reports

The Government is determined to force through tougher targets and raised thresholds for diabetes in the next draft of the quality and outcomes framework.

Diabetes tsar Dr Sue Roberts told Pulse she was confident of securing the changes ­ a reduction of HbAlc to 6.5 per cent in patients at risk of arterial disease and in blood pressure to 135/85mmHg.

Dr Roberts, also clinical co-ordinator for Northumbrian Diabetes Service, added: 'I definitely think the thresholds should increase.'

GPs have reacted with consternation to the proposals and warned the current diabetes targets are already among the hardest in the existing framework.

Dr Roberts, speaking in an exclusive interview, said: 'We are supporting the general approach that for all indicators for which NICE has got a guideline that indicator should be brought in line with NICE.

'The minor tweaking to make sure everything is in line with NICE I think will all go through.'

But GPs said the existing diabetes targets were already extremely tough, with research from Birmingham and the Black Country strategic health authority indicating a third of practices were missing out on full HbA1c target pay.

Dr Mark Browne, a GP in Derby and diabetes lead for Greater and Central Derbyshire PCTs, said: 'It's been very tough to meet some of those targets and now they want us to run faster to earn the same amount. It's punitive.'

He estimated achievement of the HbAlc target in his area varied from 35 to 85 per cent.

Dr Kambiz Boomla, senior lecturer at the centre for general practice and primary care at Queen Mary University of London and a GP in east London, said his research in Tower Hamlets, Hackney and New-ham indicated targets for HbA1c and blood pressure were the hardest in the QOF.

Dr Boomla said: 'Given the current targets are not being made I'm not convinced changing them is going to result in further improvements.'

Dr Ken Aswani, NHS Alliance diabetes spokesman and a GP in north-east London, said GPs in inner-city areas would find tougher targets especially difficult, and that the QOF was a payment system, not a gold standard.

Dr Roberts said she also strongly supported including indicators for type 1 diabetes and patient education and self-management in the next draft.

RCGP chair Dr Mayur Lakhani said: 'It would be

very hard to achieve these targets without more support through service redesign.'

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