Exclusive: Plans to bundle most of the diabetes indicators in the QOF will demotivate GPs, lead to more referrals and infringe on a patient’s right to refuse treatment, the GPC has warned.
The GPC have written to the Government in protest against Department of Health plans to force GPs to carry out nine separate checks in each patient with diabetes in order to boost achievement in the routine care of patients with diabetes.
But the DH has insisted a composite indicator would improve care for patients with diabetes and is achievable for GPs, as currently 18% of GP practices complete all nine care processes for diabetes in more than 70% of patients.
Earlier this month, Pulse revealed the DH had asked NICE to look into creating a single QOF indicator for diabetes worth more than £5,000, as well as changing the thresholds for achieving points.
The DH wrote to NICE to ask it to consider a composite diabetes indicator for which practices would have to conduct all nine checks – such as HbA1c, cholesterol, blood pressure and BMI – in every patient to get their points.
In a letter sent last month to Sir Bruce Keogh, medical director of the NHS, GPC chair Dr Laurence Buckman said a composite indicator would have ‘unintended consequences’.
He said: ‘The suggestion that GPs should only be paid for diabetes care if they ensure all nine processes are delivered would have consequences where patients did not wish to engage in some checks or continue to attend.
‘A composite indicator that defunded practices of the whole quantum of diabetic QOF funding – designed to fund the process, not just the outcomes – risks demotivating practices completely and would almost certainly have the unintended consequence of increasing diabetic referrals.’
He added that a composite indicator did not allow for a patient’s right to decline parts or all of their treatment: ‘The general ethos in primary care is co-operation with patients, and a regimented tick-box check that was mandatory to secure any funding for the service would, we believe, be extremely counterproductive to a co-operative and patient-empowering approach to diabetic care.’
But in his reply, Sir Bruce defended the plans for a composite indicator: ‘The QOF is currently not incentivising practices to increase the number of their patients who receive all nine care processes that are the hallmark of good diabetic care delivered to patients. If one or two are missed, patients are not getting the care they should receive.
‘High levels of completion should be achievable in a large proportion of patients, as evidenced by the fact that the National Diabetes Audit (NDA) report for 2010/11 shows that all nine care processes are completed for more than 70% of patients in 18% of practices, and for more than 80% in 2.2% of practices.’
The move came after the results of the 2009/10 NDA showed only 49% of patients with diabetes received all nine of the care processes recommended by NICE.
But Dr Richard Vautrey, GPC deputy chair, said GPs were being unfairly criticised: ‘There are suggestions that practices are not providing diabetic care that we know they are. We want to avoid any undue criticism of GPs.
‘We highlighted the reasons why the QOF indicators don’t match the diabetes audit. We wanted to clarify why we believe there is a discrepancy between the two. They used different parameters.’
Dr Shaun Pike, vice-chair of Worcester LMC, said NDA results for Worcestershire showed many practices had failed to carry out microalbuminuria checks when this was at odds with the high QOF achievement rates for this area.
He said: ‘It was a coding discrepancy – we were putting in the right codes for our PCT, but not the correct code for the NDA. As the audit was pass or fail, because our data wasn’t being recorded we looked as though we’d failed when we hadn’t.’
Dr Pike added: ‘We were given no right to challenge the data before it was published, and now a national glossy document has been published that makes us out to be a lot worse than we are.
‘Uncritical data extraction without scrutiny is going to lead to a misrepresentation.’
A spokesperson from the NHS Information Centre said: ‘As part of the audit, a system is in place that allows practices to review the data they have submitted and get feedback on any data quality issues. We encourage all practices to register to this system so they can address any problems with their data before it is published.’