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QOF depression screening 'waste of time and cash'

By Nerys Hairon

Screening for depression under the revised quality and outcomes framework will be a waste of money with no benefit for patients, a new assessment warns.

The analysis, based on the results of a gold standard Coch-rane review, concludes the requirement to screen patients with CHD and diabetes fulfils none of the National Screening Committee's criteria for a screening programme.

The researchers found there was 'scant' evidence screening alone would bring improvements in care or outcomes, and that the ratio of costs to benefits was 'unacceptable'.

To meet the committee's requirements, screening would need to bring therapeutic benefit and remission for more than 85 per cent of patients who screened positive ­ a target 'unlikely to be achievable'.

The researchers, whose Cochrane review examined evidence on more than 6,000 patients, found some evidence of benefit in those with concurrent chronic diseases, but only as part of a collaborative care programme.

'Screening for depression is an unhelpful diversion. It should only be introduced as part of a package of enhanced care. Without this, screening will be associated with increased costs and no benefit,' concluded the analysis, published in the BMJ.

Dr Simon Gilbody, senior lecturer in mental health services research at Hull-York medical school, who led the analysis, warned introducing screening into the QOF was 'putting the cart before the horse', because of the lack of access to depression services.

Dr Gilbody said: 'GPs could earn quite a lot of money without any demonstrable patient benefits and it's going to clog up the system and raise patient expectations. I would not start screening before you have solved everything else in the NHS.'

Dr Ian Walton, chair of Primary Care Mental Health and Education and a GPSI in mental health in Tipton, West Midlands, said: 'The findings do not surprise me and many of us are struggling with how we screen for depression. It may be that though screening for depression is not a fully valid exercise, it will force PCTs to develop treatment services in primary care mental health.'

But Dr Chris Manning, chief executive of Primhe, insisted screening of patients with CHD and diabetes was 'justifiable' based on trial evidence.

'The absence of an available intervention is not in itself a justification for not bothering to assess any individual patient's mental state or feelings about their predicament,' he said.

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