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How GPs are struggling on QOF targets

By Emma Wilkinson

Screening patients with diabetes for depression is a waste of time because they are not at any increased risk of the condition, new research concludes.

A diagnosis of diabetes has no effect on the likelihood a

patient will subsequently develop depression, concluded the study of 31,635 people with type 2 diabetes and 57,141 controls.

The findings challenge the decision to include depression screening in the revised quality and outcomes framework. They follow an analysis by Cochrane researchers in May, which found 'scant' evidence that screening would bring any improvement in care or outcomes.

'Based on these findings, people with type 2 diabetes and no previous history of depression require no more screening than the general population in primary care,' concluded the authors of the new research.

Study leader Professor Jeffrey Johnson, research chair in diabetes health outcomes at the Institute of Health Economics in Edmonton, Canada, said depression was likely to increase the risk of diabetes rather than vice versa. 'Routine screening for depression in people with new-onset type 2 diabetes is probably not warranted, but the risk should be evaluated on a case-by-case basis,' he said.

The incidence of new-onset depression was 6.5 per 1,000 person-years in patients with diabetes and 6.6 per 1,000 patient-years in those without the disease, according to the study, published in the Canadian Medical Journal last week.

The results came as a Pulse straw-poll of GPs revealed widespread discontent with the new indicators on depression. Of 18 GPs who responded, 80 per cent said resources were not sufficient to cope.

Dr Sally Hope, a GP in Oxford, said: 'It annoys me there is no evidence these patients are any more or less depressed than others with chronic ill-health – so why screen them?'

'Asking us to

spend time in working to earn

QOF points which have little or no evidence base

is very disruptive

to general


Dr Mike Tayler, a GP in Thaxten, Essex

'How on earth can you provide indicators for something as nebulous as depression – it's an example of the inappropriateness

of the QOF.'

Dr Dylan Murphy, a GP in Lerwick, Shetland

'There are long waits for mental health referrals, waits of six to 12 months for counselling and virtually no CBT – so it's Prozac as usual for many of them.'

Dr Helen Joesbury, a GP in south Sheffield

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