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Regulator warns GPs: 'Follow cardiovascular rules or risk sanctions'

By Nigel Praities

GP practices will have to comply with strict new requirements on managing cardiovascular disease or risk being denied their registration, under plans released by the health and social care regulator.

The Care Quality Commission is to step up scrutiny on practices over their implementation of NICE guidance, after finding ‘high variation' on cholesterol control, smoking cessation and generic prescribing rates.

The plans include a series of recommendations for toughening up QOF targets, to include raised thresholds and more frequent measurement of cholesterol, in a move which appears to impinge on the remit of NICE to reshape the QOF.

PCTs have also been told to scrutinise raw practice data on disease rates, prescribing and cholesterol control, to ensure practices are applying NICE guidance in full rather than simply hitting QOF targets.

Practices that cannot demonstrate they are applying NICE recommendations, or which have a prevalence of CVD below that expected in their area, could face a threat of suspension or even legal action.

A spokesperson said: ‘This information will form part of the data the CQC will use to monitor GP practices' compliance with registration requirements.

‘It will be up to the NHS in its performance management role to make use of this information to improve performance at a local level.'

The CQC's report, Closing the Gap, appears to be the first step in moves to ensure much tighter implementation of NICE guidance, although the CQC denies it is attempting to make NICE guidance compulsory.

The report criticises practices for not providing CVD prevention in a ‘planned, focused and consistent way'.

It advises NICE to increase QOF thresholds for cholesterol control and smoking cessation, to introduce points for ‘proactive case-finding' and to pay GPs for narrowing the gap between expected and recorded prevalence.

GPs are legally required to register with the CQC from 2012 and this provides the first indication of how these wide-ranging powers will be employed. Similar reports are now planned in a series of further disease areas, to include stroke, mental health and learning difficulties, and healthcare in care homes.

CQC chair Baroness Barbara Young, said she wanted to ‘raise the bar'. ‘We must encourage practices to make sure they do what the evidence shows works, redouble efforts in deprived areas and ensure prescribing is cost-efficient,' she said.

But Dr Bill Beeby, chair of the GPC's clinical and prescribing subcommittee and a GP in Middlesbrough, said the plans were ‘simplistic' and would act as a disincentive for practices to care for hard-to-manage patients.

‘It would be wrong to expect GPs to take every piece of NICE guidance and apply it to every patient religiously. That is crazy,' he said.

Professor Mike Kirby, professor of health and human sciences at the University of Hertfordshire and a GP in Radlett, said struggling practices should be given extra support and not be punished.

‘There are limits on how much interference GPs will tolerate. The idea of a stick disproportionately affecting practices working in deprived areas is very inappropriate.'

What the CQC is planning

- Practice-level data on CVD and smoking prevalence to be used to assess GPs are 'complying with registration requirements'

- Revamp of QOF with higher thresholds for cholesterol goals and extend current targets for smoking so that all smokers are offered referral to stop smoking services and medication

- NICE should recommend new indicators to incentivise GPs to proactively case-find patients with CVD and to reduce the gap between the recorded level of CVD and the estimated level

- PCTs should also ‘strongly encourage' GPs to prescribe non-branded statins and ‘formulate a clear response' to balance out inequalities in prescribing

Source: Care Quality Commission, ‘Closing the gap', September 2009

GPs face higher QOF payment thresholds for cholesterol under new recommendations GPs face higher QOF payment thresholds for cholesterol under new recommendations CQC CVD report

CQC CVD report

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