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NICE recommends annual GP checks for all patients with rheumatoid arthritis

GP practices will be required to annually review all patients with rheumatoid arthritis and assess their cardiovascular and fracture risks from next year, under proposed QOF indicators from NICE.

The proposed indicators would incentivise practices to produce a register of all patients aged 16 and over with a ‘definite' rheumatoid arthritis diagnosis from a rheumatology specialist.

It will also give points for giving those patients annual face-to-face reviews, regular cardiovascular risk assessments in those aged 40 to 85 years and fracture risk checks.

The proposed indicators were approved at the NICE QOF Indicator Advisory Committee meeting held in Manchester last week. They will now go forward as part of the menu of indicators to be considered by the GPC and NHS employers who will make the final decision on whether they will become a part of the QOF in 2013/14.

NICE advisers recommended that  QRISK2 should be used in cardiovascular risk assessments and FRAX and QFracture should be used to assess fracture risks.

The committee heard feedback from a NICE consultation which found that stakeholders supported the proposed indicators as they highlighted the importance of rheumatoid arthritis and would help raise the profile of this new clinical area for the QOF.

The proposals were piloted in 30 practices, who reported that the indicators were popular with patients as it made them feel ‘special', though there were concerns the indicators would duplicate work done in secondary care.

An indicator asking GPs to record CRP or ESR in patients with rheumatoid arthritis was not approved, as these tests were already carried out in secondary care.

Dr Donal Hynes, a member of the steering group of the Primary Care Rheumatology Society and a GP in  Somerset, said the proposals would be a lot of work, but were ‘fantastic' for patients with rheumatoid arthritis.

He said: ‘Although its known in rheumatology circles that these patients need a close eye, that's not recognised at primary care so this would be a great mechanism so these patients get the care they need.

‘It will mean an increased workload so it's right it should be included as part of QOF. This is exactly the type of thing that's perfect for QOF, which helps us to focus our efforts to areas that will have an effect on patient care The more QOF goes into the preventative side rather than reacting to illness the better.'

But Dr Chaand Nagpaul, GPC negotiator questioned whether GPs had the capacity to deliver these checks in practice.

He said: 'We will review the evidence put forward by NICE; however, while NICE might make recommendations we have to put this into the context of GPs having had additional work forced on them because of changes to the QOF.

‘GPs at the LMC conference voted for stability in the QOF. That has to be our priority, ensuring GPs can deliver the current system.'


BOX: Full wording of the proposed indicators


The practice can produce a register of all patients aged 16 years and over with rheumatoid arthritis.

The percentage of patients with rheumatoid arthritis aged 40 -85 years who

have had a cardiovascular risk assessment using a CVD risk assessment tool adjusted for RA in the preceding 15 months (with appropriate exclusions).

The percentage of patients with rheumatoid arthritis who have had an assessment of fracture risk using a risk assessment tool adjusted for RA in the preceding 27 months.

The percentage of patients with rheumatoid arthritis who have had a face to face annual review in the preceding 15 months.


Not approved:


The percentage of patients with rheumatoid arthritis in whom CRP or ESR has been recorded at least once in the preceding 15 months.


Source: NICE


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