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GPs face crackdown on adherence to NICE guidelines after Government unveils new targets for diabetes



GPs will be expected to double the percentage of adults with type 2 diabetes who achieve NICE-recommended blood glucose, blood pressure and cholesterol levels in five years, under new targets set by the Government.

The Government said more should be done by GPs to make sure that risk factors were controlled in diabetes and set a target for 40% of patients with diabetes to be within NICE-recommended levels, which is double the current rate of 19.8% by 2018.

It also recommends a dramatic increase in the proportion of patients with diabetes being given nine basic care processes annually – such as foot checks and microalbuminuria tests – from 50% to 80% by 2018, possibly by bundling the QOF indicators together.

Pulse revealed last year that ministers had written to NICE to ask it to explore the practicality of raising QOF thresholds and creating a ‘composite’ indicator in QOF for diabetes worth over £5,000.

The targets were revealed in a response from the Treasury to a report published by the House of Commons Public Accounts Committee that was very critical of GP management of diabetes last year.

The PAC said too few patients were achieving the recommended levels for blood pressure, cholesterol and diabetes and called for QOF indicators to be bundled.

In its response, the Treasury said: ‘It will never be appropriate for every person with diabetes to be within the recommended outcomes ranges defined by NICE, which are set for the UK population as a whole. The specific proportion cannot be defined, particularly for glucose control.

‘However, the department agrees that more can be done to increase the proportion of people with diabetes achieving the recommended levels for blood glucose, blood pressure and cholesterol.’

The Treasury said it recommended changes to QOF, although this would be up to NICE’s assessment of whether to bundle indicators and the NHS Commissioning Board.

It said: ‘The current payment system is not driving the required outcomes. GPs are paid for each individual test they carry out rather than being rewarded for ensuring all nine tests are delivered.’

The QOF revisions – especially relating to microalbuminuria testing and the DM13 indicator – are expected to help achieve ‘universal’ annual coverage for the nine basic diabetes care processes, the Treasury added.

But it rejected a recommendation for GP contracts to include mandatory provisions for multi-disciplinary care and structured support for people with diabetes.

‘The Government does not consider it is appropriate for the department or the NHS Commissioning Board to mandate which individuals should provide specific elements of care,’ it said.

Dr Bill Beeby, chair of the GPC’s clinical and prescribing subcommittee said the targets set by the Treasury were unrealistic as they depended on patients attending appointments and acting on the medical advice they were given.

He said: ‘One of the main reasons why things are often out of control in diabetes is because patients just don’t listen to medical advice.

‘The QOF was never designed to achieve the things the Treasury is suggesting. The concept that it is all about incentives and that we GPs will chase these things down until the last man standing is quite erroneous. If a patient does not come in for a test there’s only so many times you can phone them.’

 

Pulse Live: 30 April – 1 May, Birmingham

Pulse Live

Find out what is new in diabetes screening and treatment from diabetologist Professor Martin Stevens at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers, will cover the latest developments in telehealth.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.