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Pressure cranks up on CKD as GPs face tougher targets

GPs face even tougher targets for chronic kidney disease in future versions of the quality and outcomes framework. Pulse can reveal that the current indicators are only the first stage of a rolling programme.

The 140/85mmHg blood pressure target should be 'tightened in successive years' and tough new indicators added on managing anaemia, the QOF expert review group has advised.

The recommendations came in one of a series of reports obtained by Pulse which shine light on the future of the QOF – with proposals for targets on assessing eligibility for benefits and screening for alcohol misuse.

But the planned indicators on CKD will provoke particular consternation among GPs, coming as a Pulse straw-poll revealed that two-thirds are finding it hard to cope with the existing targets and more than half believe CKD points to be inadequate.

Plans were submitted to negotiators by the QOF expert review group last year – with most recommendations for the first phase of the programme included in this year's QOF.

But the group also proposed moving to a target of 130/80mmHg, or 125/85mmHg for patients with proteinuria, after 'one to two years' of data collection. And it recommended a target of greater than 11g/dl haemoglobin for all CKD patients on a practice register – to be implemented in the first review following publication of new NICE guidance due in September.

Dr Simon de Lusignan, author of the group's report and senior lecturer in primary care informatics at St George's, London, said: 'We may not have set the BP target strictly enough. Guidelines suggest 130/80 as an appropriate target, lower if there is persistent proteinuria. But controlling BP can be challenging.'

He added: 'The concept of eGFR is new to many GPs and in time we may have to move from looking at absolute value of eGFR to rate of change.'

The Department of Health said a new independent panel would be announced soon and continuous improvement 'has been agreed as an un-

derpinning concept of the QOF'.

But GPs are already finding CKD targets a huge workload.

Dr Gary Calver, secretary of Kent LMC, said: 'I'm not sure anyone realised quite how much work bringing in renal indicators was going to cause.'

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