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GPs go forth

Most PMS practices to use GMS quality framework for now

By Nerys Hairon

Most PMS practices are planning to ignore the opportunity to develop their own quality and outcomes framework this year and plump for the GMS version.

But PMS GPs say they will make changes in future years when they have collected evidence to justify the move.

Government guidance released in conjunction with the GMS contract documents gave PMS practices the right to adapt the quality framework to suit local needs.

PCOs will decide whether GPs' suggested changes are evidence based and of equivalent workload and health outcome to the markers in the national framework they replace.

The only stipulation is the locally-negotiated PMS quality framework has to add up to 1,050 points and have the same 550/500 split between clinical and organisational markers.

Dr Peter Smith, chair of the National Association of Primary Care and a PMS GP in Kingston, Surrey, said his practice wanted to get used to working to the new system before making changes.

'At the moment the majority of people are looking to use the framework as it is,' he said. 'I have no doubt people will want to rewrite it in time, but what we want to do is get ourselves into the system.'

Examples of modification the practice was considering included adding depression as a marker and concentrating more on hypertension within the diabetes indicator, he said.

Dr Graham Archard, a GP in Christchurch, Dorset, said his practice may eventually alter the framework to include fewer cholesterol checks for stroke patients.

Dr Bhargawa Vasudaven said his practice in Gravesend, Kent, did not have enough data to support any changes but was looking to make some in future.

But Dr James Kingsland, a GP in Wallasey and Liverpool, and a former Government adviser on PMS, was 'incredibly disappointed' at the way PMS was becoming an 'annually target driven framework'. He said: 'I am hoping we are going to have nothing of [the quality framework]. If people want to choose GMS and all the restrictions that's fine, but the early waves of PMS seem to have been discarded.'

Seven ways PMS practices can adapt the GMS quality and outcomes framework

 · A core from the national quality framework plus local add-ons Core is drawn from national scheme, with options to be developed locally. Or use a reputable source for an 'off-the-shelf' version.

 · Different interventions for related fields

For example, replace patient surveys with a patient involvement group. In clinical fields this should have an equal evidence base.

 · Fewer indicators for the same disease areas Practice would still have to demonstrate adequacy of other aspects of services in those areas at annual review.

 · Local use of different indicators

Include indicators discussed but not used in national GMS framework, such as depression.

 · Use a different evidence base relevant in new disease areas to fulfil local sensitivity This still has to be an acceptable body of evidence.

 · Use organisational quality frameworks such as Quality Team Development in a fuller way rather than replacing organisational markers Appropriate points total still has to be ascribed to this activity.

 · Different approaches For example, points for development of public health interventions such as care of homeless patients.

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