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Three-quarters of GPs support QOF age caps to protect elderly from 'over-treatment'

Exclusive Three out of four GPs back age caps on QOF indicators, amid huge concerns over over-treatment of the elderly and lack of confidence in the exception reporting system, a Pulse survey commissioned by guest editor Dr Helena McKeown reveals.

But GPC negotiators have dismissed age restrictions as ‘simplistic' and potentially illegal, even though NICE itself has agreed to pilot age caps in trials of two new hypertension indicators, and has already placed a cap at 74 on indicator PP1.

A Pulse survey of nearly 300 GPs found 73% of GPs supported age caps on QOF indicators, and 80% said they believed people over 80 were ‘substantially over-treated' for chronic conditions. Only 27% of GPs had faith in exception reporting to protect patients.

Dr Hazel Drury, a GP in Rhuddlan, North Wales, said: ‘Age caps are needed. They are simplistic but the fact is some of the medications we are being told to prescribe can be detrimental to elderly patients. We get told to use exception reporting, but when we do it regularly we get picked up on it.'

But GPC negotiators said they would not be lobbying NICE to introduce age caps, arguing such a move ignored the complexity of healthcare and could contravene age discrimination laws.

Dr Chaand Nagpaul, a GPC negotiator and GP in Stanmore, Middlesex, said: ‘It would be simplistic and iniquitous to specify an age beyond which a patient should not be entitled to treatments. GPs should not feel compelled to offer treatment if the patient is unlikely to benefit from it. Those cases can arise due to a number of factors, not just age, but QOF allows for exception reporting to ensure GPs are not penalised for exercising clinical judgement.' 

Asked if age caps will be on the negotiating table in future QOF discussions, Dr Richard Vautrey, deputy chair of the GPC and a GP in Leeds, said: ‘They won't be I'm afraid because of anti-discrimination laws. I realise it's something many people would like to see but the reality of introducing it is difficult. We would advise GPs to use their clinical discretion. QOF's exception reporting provisions are there to support them in that.'

Age caps can only be legally introduced in QOF for indicators where there is ‘overwhelming evidence' to prove treatment only benefits certain age groups, said Dr Vautrey. In 2009 NICE announced that hypertension indicator PP1 would only apply to patients aged 30 to 74 on this basis.

Last month NICE's QOF indicator advisory committee said a pilot would give GPs chasing blood pressure targets ‘flexibility' to exclude patients over 80. A NICE spokesperson said it was ‘not currently considering' introducing age caps to any further indicators.

A Department of Health spokesperson said: ‘The QOF guidance already takes age into account where this is clinically relevant. GP practices can also choose to exception report a patient if they decide that achievement of a particular indicator is not clinically appropriate.'

Click here to read more from Dr Helena McKeown's guest editor issue

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