GPs set to miss out on quality points for kidney disease
By Danusia Osiowy
GPs will find it almost impossible to hit tough new targets for controlling blood pressure in the chronic kidney disease domain of the revised QOF, an NHS study warns.
An intensive programme of BP control in general practice was unable to produce anything like the results seen in clinical trials, the study found.
The researchers said their findings put the NICE diabetes target and contract CKD target out of reach of most GPs and warned against moves to toughen up future versions of the QOF based on trial results.
The study of over 1,500 GP patients with type 2 diabetes, published on the NHS Research Findings Register and submitted to the BJGP, found a stepwise, target-based programme increased consultations and doses of medication but failed to improve BP control.
Only a third of patients in the intervention group hit the NICE 140/80mmHg blood pressure target for diabetes no better than with standard care.
Study leader Dr Nigel Sturrock, consultant physician in
diabetes and endocrinology at Nottingham University Hospitals NHS trust, told Pulse: 'It's very difficult to control BP in
real life. In day-to-day practice, even with heightened awareness and a simple step-by-step
algorithm, we didn't see any improvement in control compared with standard practice.'
He warned that although his study had looked at patients with diabetes, the results also suggested the 140/85mmHg CKD target would be extremely hard for GPs to hit. The mean BP achieved by the intervention group was 143/78mmHg.
'It is the same problem for primary care regardless of the underlying reason for wishing to achieve tight control. The GP QOF points are based on published scientific studies that were heavily resourced and with committed patients,' he said.
Dr Laurence Buckman, dep-uty chair of the GPC, insisted the new targets set for GPs were achievable. 'If standards are set too high it is inevitable that exception reporting could happen but it's not in anyone's interest. The targets at the moment are deliverable by most practices.'
Dr Martin Hadley-Brown, chair of the Primary Care Diabetes Society and a GP in Thetford, Norfolk, warned GPs to expect even tougher QOF targets.
'Practices achieved so well it is almost inevitable the Government will tighten standards. Instead, they should encompass other areas such as structured education and information for patients,' he said.