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GP federation agrees 'payment by results' contract to provide diabetes services

A federation of GP practices has agreed a ‘pioneering’ payment-by-results contract with local commissioners to provide diabetes services.

Under the terms of the contract – agreed between the Suffolk GP Federation not-for-profit community interest company and North East Essex – 25% of the federation’s income will be dependent on performance on aspects such as HbA1c test results and cholesterol levels.

Payment will also be part-dependent on the completion of annual reviews and ensuring that newly diagnosed patients receive education about their condition.

The CCG believes the scheme will help reduce the numbers of patients who need hospital admission.

Patients and healthcare professionals will be consulted about the contract plans before they are finalised, ahead of a service launch in April 2014.

Dr Tim Reed, chair of Suffolk GP Federation, said: ‘This is a pioneering contract both in terms of payment by results and the way it provides an integrated approach for patients, who will find it easier to book and attend their diabetes appointments by using a single point of contact and by assessing higher-level care locally to where they live. To achieve this we will be working very closely with all the GP practices in the Colchester and Tendring areas, and with Colchester Hospital, who will provide specialist care and clinics for those with complex needs.’

The Diabetes UK charity, which was consulted on the plans, is supportive of the payments system. Its regional manager Sharon Roberts said: ‘We have seen a very thorough approach to engaging people in the improvement of their healthcare services.’

Readers' comments (11)

  • Assume they won't be paid for QOF as sounds like they will be paid twice.

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  • This has a serious risk of perverse incentives and unintended consequences.

    Up-to-date guidance stresses how HbA1c targets must be individualised. There is no evidence of clinical benefit from good glycemic control in some patient groups and serious harm can results from over-tight control. Likewise low cholesterol levels are sometimes not achieved without significant side-effects from the medication. I doubt the system is sophisticated enough to account for different targets in different people.

    Would you trust clinical advice if you knew 25% of income depended on achieving a numerical target? and who gets the payment if the target is achieved - the GP, the hospital, the consortium?

    Secondly - how is this not paying for the same thing twice over? QOF and PbR - butter and jam for tea methinks

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  • The above posters have no clue what they are talking about and obviously happy for diabetic patients to have crap care .
    Any extra investment to improve the care of diabetic pts is always welcome especially when current investment is ridiculous
    At present I think if diabetic care is funded via Qof only I think it works out for a practice 40 pounds per diabetic pt per year and that's only if the diabetic targets are met.

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  • 7:28

    If you are a fellow professional, then please stick to criticising arguments in a scientific and constructive manner. If not, then this is not the forum for you.

    The concerns we raise are real and, if not addressed, would mean that these type of schemes simply line the pockets of the professionals, whilst actually delivering worse care.

    Humans respond to incentives by gaming the system and throwing money at them will solve nothing.

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  • Diabetes is not core gp work, and actually from a profit point of view it's more profitable to miss the Qof payments and not bother do any diabetes work and refer everyone to hospital.

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  • More dumbed down care for people with diabetes from box-ticking doctors.

    People with LTCs do 99.97% of the work of managing their diseases. Why should doctors get financial incentives for giving dumbed-down "care" when it is the patients doing all the work?

    The bonus money should be put toward more pumps and test strips and better provision of formal education for all people with diabetes.

    If doctors are really the "professionals" they claim to be, they should care for sick people because it's part of their "professional" responsibilities, not for financial bonuses for hitting some simplistic targets that may well ending up harming patients with diabetes.

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  • Phil Yates

    Given the cost of poorly-controlled diabetes to the patient and the NHS, any support for improving that care must be welcomed. It's shocking how poor understanding of the disease and its control is still by people with diabetes and a major thrust of this work must be on education, support for behavioural change and provision of immediate advice for the patient when problems ensue.

    There is no reason that diabetes care shouldn't be almost entirely community delivered. Pump-priming this change is sensible and necessary. With proper time and investment we can tailor the achievement of 'good control' much more to the individual. None of us want to under or over intervene with our patients.

    Let's not knock this scheme. Transformation of diabetes care has been a long time coming.

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  • Put together all the pieces. Bring GPs into conflict of faith and trust with 'maggots' story and continued media bashing in the public eye and you undermine the patient GP relationship. Remove seniority pay thru new contract, and make university fees so high for 6 years' study that there will be fewer GPs in future, as medical students choose to become higher paid specialists. The Diabetes type study is a pilot to change the pay structure for GPs in preventative care for target-led payment. Profit making parts stay with CCGs, public health and preventative care managed in joint LA budgets together with Social Care. (Pooled budgets planned for 2014/15 ADASS). GPs are being undermined via the press so as to weaken the position to stand up against these changes, all made in the name of 'quality' and patient care. The budget ownership via CCGs breaks up payment processes and privatises many services. Kingsley Manning, very pro privatisation and ex-head of Tribal Newchurch (benchmarking), is Board Chairman of HSCIC - head of extractions. Tim Kelsey, National Director for Patients and Information, founded Dr.Foster. GPs are in for a rough ride for some time to come, until the Family Doctor model as we know it, no longer exists. I will be sad to see that happen.

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  • " It's shocking how poor understanding of the disease and its control is still by people with diabetes and a major thrust of this work must be on education."

    I find it shocking how many GPs don't know the difference between T1 and T2 and don't know the first thing about dosing insulin, yet feel they can claim QOF money for running "diabetic" clinics.

    Poorly educated doctors in the community are harmful to patients with diabetes. There's no reason they should be given "bonus money" for running clinics for a disease about which they have no interest, training or education.

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  • There is no Qof money for running diabetic clinics.

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