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When should I treat low haematinic levels?

GPs face an uphill battle to achieve lucrative quality pay for hypertension because the blood pressure target in the contract is far too optimistic, experts are warning.

Practices will struggle to get even 50 per cent of patients to hit the 150/90 target, claimed Professor Tom MacDonald, whose new study has exposed the shortcomings of GP hypertension management.

And Professor Bryan Will-iams, a member of the guideline committees for both NICE and the British Hypertension Society, warned the quality target would be 'unattainable' without a seachange in GPs' attitudes to polypharmacy.

Hypertension is the most lucrative element in the framework with a total of £5,625 available to the average three-partner practice for getting 70 per cent of hypertensive and CHD patients to target.

But the research suggests many practices will miss out on much of the cash. Professor MacDonald, a member of the BHS executive committee and professor of clinical pharmacology and therapeutics at the University of Dundee, said: 'People don't attain treatment goals very often. Judging by the level of patients treated to target it is optimistic to get over 50 per cent to [the quality] target.'

He predicted GPs would resort to referring more patients and make liberal use of exception reporting in a bid to increase their earnings.

Professor Williams, professor of medicine at the University of Leicester, said: 'If GPs continue to use monotherapy to treat hypertension in the majority of patients then the target is unattainable.'

GP Dr Ian Millington, secretary of Morgannwg LMC, said GPs would 'struggle to get patients down to those levels'.

Dr Peter Davies, a GP in Halifax, warned some GPs would resort to 'gaming' with 'strategy used in BP checks in the run-up to the quality and outcomes cut-off date'.

The study, presented at the International Society for Phar-macoepidemiology conference, analysed data on 55,000 patients from the UK general practice research database. Among patients with both hypertension and dyslipidaemia, only 21 per cent hit the 140/90mmHg NICE target.

By Rob Finch

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