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Raised top thresholds mean running harder to stand still

GPs will have to work harder this year just to stand still after raised maximum thresholds were unveiled across a wide range of existing quality indicators, writes Daniel Cressey.

Thousands of practices that hit maximum points in this year's QOF will have to raise their game if they want to do the same again.

Top thresholds have jumped 10 percentage points on CHD targets for cholesterol, ?-blockers and use of ACE inhibitors or ARBs in myocardial infarction.

There are similar rises for cholesterol control in diabetes, use of ACE inhibitors or ARBs in heart failure and of ACE inhibitors in patients with proteinuria or micro-albuminuria (see box, left).

All of the minimum thresholds are moving up to 40 per cent, as Pulse has previously reported.

This means GPs will also have to get more patients to target to achieve scores intermediate between minimum and maximum thresholds.

Dr Peter Dixon, an NHS Employers negotiator, said: 'The rationale was that QOF is continually evolving as a means of improving quality. It's appropriate to raise the thresholds.'

Dr Dixon added that the particular indicators had been chosen as they were thought to be most important in quality terms. 'It is a quality issue ­ that was the major decider.'

Dr Hamish Meldrum, GPC chair, said: 'It's always been understood that the QOF would not stand still ­ it was part of the agreement that we were meant to be continually trying to improve quality.

'It shouldn't be that much more difficult. I would hope these fears would not be true for more than a very small number of practices.'

But a Pulse analysis of QOF data indicates that under the new thresholds, 30 per cent of practices will have to bring more diabetes patients to target for cholesterol to hit top points again, and 23 per cent of practices will have to do so in CHD.

Dr Thomas Bloch, a GP in Worcestershire, said: 'It's win-win for the Government ­ it forks out less for the same.

'We worked hard to get the levels last year, and we'll have to work even harder this year.'

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