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Meltdown in store for GPs over quality

The Department of Health is demanding strategic health authorities clamp down on PCTs that attempt to implement regional variations on the quality and outcomes framework.

The warning came after a PCT came under widespread criticism for agreeing to pay GPs quality money without requiring them to hit cholesterol targets in the framework.

The NHS Confederation said it was 'concerned' that GPs could be rewarded with points without fulfilling requirements of the quality framework. And the GPC said elements of the PCT scheme were 'poor medical practice'.

North Eastern Derbyshire PCT's statins policy allows GPs to exception report patients whose initial cholesterol was below 6.2mmol/l without re-testing and those not brought to target by 40mg simvastatin.

Chesterfield and High Peak and Dales PCTs share the policy but insist they will not allow exception reporting in the same circumstances.

But North Eastern Derbyshire PCT vigorously defended its rules on exception reporting. A spokeswoman said: 'The evidence base for the quality framework is not up to date and North Eastern Derbyshire has exceeded national targets for statin prescribing.'

The trust quoted the UK Heart Protection Study, which it said provided 'clear evidence' for the benefits of 40mg simvastatin in secondary prevention.

Prescribing lead Dr Ruth Cooper, a GP in Tibshelf, Derbyshire, insisted quality care was 'about affecting outcomes, not about reaching the magic number of five'.

The local LMC is supporting the scheme. Derbyshire LMC secretary Dr John Grenville said: 'This is stretching the interpretation of the rules but I don't think it goes outside them. I think there will be a lively debate about whether it's acceptable or not.'

But the department indicated in strong terms it did not feel the scheme was acceptable. It said: 'GMS practices are unable to vary the quality and outcomes framework and we definitely would not support a practice or PCT attempting to do so. We expect SHAs to check PCTs and practices are meeting national standards.'

GPC Wales chair Dr Andrew Dearden insisted trusts should pass new evidence to the Q&O review group for consideration. 'That is why there is a review group. Otherwise we will have more than 300 different frameworks based on whatever study the PCT read that week,' he said.

By Nerys Hairon

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