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Independents' Day

GPs face crackdown on adherence to NICE guidelines after Government unveils new targets for diabetes

GPs will be expected to double the percentage of adults with type 2 diabetes who achieve NICE-recommended blood glucose, blood pressure and cholesterol levels in five years, under new targets set by the Government.

The Government said more should be done by GPs to make sure that risk factors were controlled in diabetes and set a target for 40% of patients with diabetes to be within NICE-recommended levels, which is double the current rate of 19.8% by 2018.

It also recommends a dramatic increase in the proportion of patients with diabetes being given nine basic care processes annually - such as foot checks and microalbuminuria tests - from 50% to 80% by 2018, possibly by bundling the QOF indicators together.

Pulse revealed last year that ministers had written to NICE to ask it to explore the practicality of raising QOF thresholds and creating a ‘composite’ indicator in QOF for diabetes worth over £5,000.

The targets were revealed in a response from the Treasury to a report published by the House of Commons Public Accounts Committee that was very critical of GP management of diabetes last year.

The PAC said too few patients were achieving the recommended levels for blood pressure, cholesterol and diabetes and called for QOF indicators to be bundled.

In its response, the Treasury said: ‘It will never be appropriate for every person with diabetes to be within the recommended outcomes ranges defined by NICE, which are set for the UK population as a whole. The specific proportion cannot be defined, particularly for glucose control.

‘However, the department agrees that more can be done to increase the proportion of people with diabetes achieving the recommended levels for blood glucose, blood pressure and cholesterol.’

The Treasury said it recommended changes to QOF, although this would be up to NICE’s assessment of whether to bundle indicators and the NHS Commissioning Board.

It said: ‘The current payment system is not driving the required outcomes. GPs are paid for each individual test they carry out rather than being rewarded for ensuring all nine tests are delivered.’

The QOF revisions – especially relating to microalbuminuria testing and the DM13 indicator – are expected to help achieve ‘universal’ annual coverage for the nine basic diabetes care processes, the Treasury added.

But it rejected a recommendation for GP contracts to include mandatory provisions for multi-disciplinary care and structured support for people with diabetes.

‘The Government does not consider it is appropriate for the department or the NHS Commissioning Board to mandate which individuals should provide specific elements of care,’ it said.

Dr Bill Beeby, chair of the GPC’s clinical and prescribing subcommittee said the targets set by the Treasury were unrealistic as they depended on patients attending appointments and acting on the medical advice they were given.

He said: ‘One of the main reasons why things are often out of control in diabetes is because patients just don’t listen to medical advice.

‘The QOF was never designed to achieve the things the Treasury is suggesting. The concept that it is all about incentives and that we GPs will chase these things down until the last man standing is quite erroneous. If a patient does not come in for a test there’s only so many times you can phone them.’


Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

Find out what is new in diabetes screening and treatment from diabetologist Professor Martin Stevens at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers, will cover the latest developments in telehealth.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.

Readers' comments (8)

  • Hussain Gandhi

    What I find most interesting is that at RCGP conference year before last, the man from NICE that attended (cant remember name now, Michael I think?) stated that NICE guidance are only single disease guidance documents, and so for multi-morbid patients can not be adhered to in the same way, yet we as GPs are now being asked to use single disease GUIDANCE documents to manage what is more commonly multi-morbid patients.

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  • As a member of the south of England IDOP steering group and carrying a special interest in residential care I am immediately prompted to make a point about some of the Diabetes UK data that highlights a very critical group of patients often not acknowledged well enough - those in care homes and nursing homes. There are well over 400,000 people living in care homes in England evidence suggests that 1;4 are diabetic only 23% of residents are screened at the point of placement, only 28% get an annual review of status and every 25 minutes someone from residential care is admitted to hospital - the massive percentage being as an unplanned or emergency admission - work should be done to address this and also address the huge cost and distress impact for clincians, commissioners, patients and families alike.

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  • Composite indicators are impossible to achieve. Even if a practice achieves 90% for each single indicator this does not translate into 90% across the board, as it is different patients in each group.
    The way it works, is that you probably get a 90% proportion in the second group from the first group, and so on until the 9th indicator.
    So, 90%x90%x90%x90%x90%x90%x90%x90%x90%= 38.7%.
    To set target any higher than this would be impossible to achieve and at this level undermines its validity. It is best to abandon this proposal and should be resisted in QOF negotiations

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  • Having had twin cousins with insulin dependent diabetes have been interested in its treatment & care. So went to the Link Care in the Community Meetings where lay persons offering swimming were going to replace Doctors .I was horrified especially knowing how incorrect my shortened online Medical Records are .Shortened by someone on a Corporate Remit. Oh dear. Surely it is the chronic multi conditions that are the most challenging to treat?

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  • Our friends in medicines management with their short term cheap is best policy will kill this. Never mind that we can make significant downstream savings with reduced admissions and complications. The sacred cow of the narrow prescribing budget will win out. Interesting how a commisiioned pharmacist with a CSU will manage the conflict of CCG policy that they do not like.

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  • Yesterday we had a LMC sponsered meeting with Jeremy Hunt.

    In his words (and I didn't believe a word of it, nor did most other GPs I spoke with), the QoF targets and DES are designed to improve care, and not designed to decrease GP income.

    Based on this, I might just give up QoF on DM all together - it's increasingly impossible to achieve and I can't justify neglecting other clinical areas (many of which are not topical and has no money attached to treating but never the less, importent) just to achive the targets.

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  • "In his words (and I didn't believe a word of it, nor did most other GPs I spoke with), the QoF targets and DES are designed to improve care, and not designed to decrease GP income."

    I despise what is happening to the NHS reorganisation, but the above comment is common sense to me. GPs and QOF was always in my observation intended to improve patient care, when as a junior practice nurse, GPs on two occasions had told me not to look for diabetes as it meant more work for the practice.

    What astounds me, is why "they" are putting GPs in charge of what was already a corrupt system.

    It's also "funny" (peculiar) why hypertension appears to have become overtreated, often on one reading, when prior to QOF I observed patients going for years, even a decade, being untreated.

    I am even more astounded that any GP could think QOF was designed to improve a GPs income!

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  • It's just a thought but maybe as in so many cases we have over complicated the whole thing. What are we trying to treat, diabetes or cardiovascular mortality liked to diabetes. If the latter I would just ask what is the greatest contributor to CV mortality in diabetes? Thus maybe we should decouple and just treat diabetes with its directly related factors as foot ulcers, neuropathy and take the whole CV part out of the indicators. I think it would make life easier and focus care on the right things.

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