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New work but scant reward

During negotiations for the revised QOF, the GPC and NHS Employers stuck rigidly to their agreed line, insisting GPs could expect only minor tweaks. Even when the new indicators were unveiled it suited both parties to portray the changes as merely evolutionary.

But the more GPs learn of the new indicators, the less they seem like a gradual progression and more like a sudden lurch into the unknown. First it emerged that a fifth of patients with diabetes will be diagnosed with depression ­ an extra workload complicated by the lack of evidence-based treatments for those distressed by chronic illness.

Such a prospect is worrying enough, but is comprehensively trumped by this week's warnings over chronic kidney disease.

Astronomical task

A series of audits suggest an astonishing 10 per cent of GPs' entire practice populations will be diagnosed with CKD under the new QOF ­ almost twice as many as the GPC had anticipated in agreeing revisions. Hitting the stringent 140/85mmHg BP target in this number of patients will be an astronomical task, especially given that fewer than half will currently be receiving appropriate medication.

The research highlights the need to focus on the huge CKD problem, but also the inadequacies of the rewards offered to GPs for doing so.

The GPC must ensure that next time it sits round the negotiating table, it does so with a renewed determination to get GPs the deal they deserve.

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