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QOF veto hits GP heart failure care

By Nigel Praities

Significant improvements made by GPs in heart failure treatment are threatened by the government's decision to block a new QOF indicator and shift more care out of hospitals, warn experts.

A Healthcare Commission study has looked at patients admitted to 176 of the 177 acute trusts in England from 2005 to 2006 and has criticised trusts for not treating acute patients to guideline standards and failing to follow them up.

But GPs were found to have made ‘substantial improvements' in heart failure care with beta-blocker use up to 39% from 10% in 2002. Over half the patients admitted had also had a echocardiogram a figure that ‘is likely to improve further … as a result of QOF'.

The authors say that although there is still scope for improvement - especially with regards to beta-blocker use – GPs should be singled out for praise.

But Pulse has learned that the new QOF indicator for heart failure – rejected by the government last month in contract negotiations – was to be for beta-blocker use.

Professor Martin Cowie, chair of the British Society for Heart Failure and an author of the Healthcare Commission report, decried the governments decision as a ‘missed opportunity'.

‘I don't know if extended hours will save many lives but beta blockade use, which is relatively simple to do for hundreds of thousands of patients with heart failure would save many lives.'

Dr Ahmet Fuat, a cardiology GPSI in Darlington who runs a specialist heart failure clinic agreed, saying incentives were needed for beta-blockers, as they were a costly intervention.

‘Getting a patient on beta-blockers can be very time-consuming - it could take you six visits. But the government is more interested in access for the worried well,' he said.

Dr Fuat added that the Healthcare Commission finding that only 20% of patients had specialist heart failure follow-up was a ‘shocking indictment' of heart failure care.

This is likely to worsen, as the NHS plans to shift more care into the community through its High Volume Care Programme, as Pulse revealed earlier this month.

Professor Cowie criticised these plans, saying patient care would suffer. ‘It is a bit foolish asking the community to pick up the pieces and improve things, as GPs often don't have the time, the experience or the confidence.'

Heart failure squeeze

- A 10-point QOF indicator for beta-blocker use was rejected by the government in January, in favour of reallocating QOF points for extended access

- The Healthcare Commission survey reveals widespread undertreatment of patients in primary care, especially with beta-blockers: only 39% of patients with a previous diagnosis of heart failure surveyed were treated with beta-blockers. The situation is even worse for women, with only 35% of women on the drugs

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