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GPs set for QOF points on ‘biopsychosocial’ checks in patients with depression

GPs will have to review all patients with depression within a month and make a full ‘biopsychosocial' assessment of their living conditions and social support, under proposed QOF indicators.

The two indicators were approved for development for next year's QOF by a NICE QOF Indicator Committee at a meeting last week, would massively extend the checks in patients with depression if given the green light by the BMA and NHS Employers.

The two indicators give points for review recently-diagnosed patients with depression within 10-35 days. They also require practices to make a full ‘biopsychosocial' assessment as part of the diagnosis of depression.

The biopsychosocial analysis will be divided into 16 ‘themes', including a patient's symptoms, any alcohol and substance use, suicidal ideation and any family history of mental illness.

GPs will also have to look at the quality of interpersonal relationships, an assessment of social support, living conditions, any employment/financial worries and have a discussion over treatment options.

The indicators have been criticised by GPs, who say they are trying to get primary care to ‘solve social problems', but were piloted in 30 practices and were received favourably, with 46.7% in favour of the first indicator, and 76.7% in favour of the second. However, only 33.3% felt that the impact on workload would be ‘minimal'.

Members of the NICE committee, said telephone reviews should be permitted if a GP is very experienced and had known the patient a long time, but face-to-face consultations were the ideal.

The indicators were approved for further development in pilot practices for the QOF in 2013/14 and the committee will look at them again at their next meeting in December.

Dr Ian Walton, a GP in Tipton, West Midlands, and chair of Primary Care Mental Health and Education and said the indicators were well-meaning, but would simply ‘frustrate' GPs.

He said: ‘Were trying to fix everything with QOF when what we need are decent primary care links with social housing, social services, debt management and education institutions.

‘They're trying to get GPs to solve social problems, but where are the services to help us? We'd refer them to social services that have been slashed to ribbons. It's trying to get primary care to solve social problems, and it can't.'


Proposed indicators*

1. The percentage of patients with depression in the preceding 1 April to 31 March who have had a bio-psychosocial assessment by the point of diagnosis with a reasonable timeframe before and after

2. The percentage of patients with depression (in the preceding 1 April to 31 March) who have been reviewed within 10- 35 days of the diagnosis

*wording may change after recommendations from the pilot practices