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Warning on over-medicalisation

QOF 'drives over-use of BP drugs'

Specialists have echoed GP fears over the target-driven NHS after warning that the GP contract is driving over-medicalisation.

Their concerns are revealed in a new Pulse survey and indicate disquiet over the effects of the quality and outcomes framework stretches beyond primary care.

It follows last week's news that the GPC is examining the evidence for introduction of age caps into the QOF to prevent the elderly from being over-treated.

Two-thirds of cardiologists who responded to the Pulse snap poll said they believed the GMS contract had 'driven over-medicalisation in relation to hypertension drugs'.

Postural hypotension and electrolyte imbalance were among the areas of concern (see box). A minority of respondents – four of the 22 – said they had seen an increase in adverse events since the contract.

Dr Justin Cooke, one of the respondents and a consultant cardiologist at Chesterfield Royal Hospital, said: 'The risks of polypharmacy in the 80-plus group are completely unknown and proper studies are urgently needed.

'We have embarked on a massive venture without knowing what the outcome will be – a theme running throughout the modern NHS.'

Dr David Gray, reader in medicine at the University of Nottingham and cardiology consultant at Queen's Medical Centre, Nottingham, said: 'I don't believe targets for the elderly should be pursued for generating points and income. There appears to have been little thought to treat patients as individuals.'

GPs are divided about wheth-er the QOF should be capped by age.

Dr Paul Roblin, chief executive of Thames Valley LMCs, said: 'It does need looking at.'

Spotting signs of over-treatment

Cardiologist advice on what to look out for

• Postural hypotension – lie patient down for two or three minutes, then stand for about a minute and measure blood pressure

• Hyponatraemia and hypokalaemia – be alert for the signs, especially with

diuretics, and check urea and electrolytes

• Over-use of ß-blockers – check doses, as patients do not necessarily need to be pushed up to those used in clinical trials

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