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MPs back plan to bundle diabetes QOF indicators

MPs have backed Department of Health proposals to bundle most of the diabetes points in QOF to create a single indicator worth over £5,000.

The Public Accounts Committee - a cross-party committee of MPs - said the National Diabetes Audit had shown the current QOF system was not driving better outcomes and GPs needed tougher targets.

The calls come as Pulse obtained a copy of an investigation by the DH into discrepancies between the results of the National Diabetes Audit and QOF.

The investigation shows that performance under QOF may be even lower than previously thought, with only 40% of patients with diabetes receiving all nine checks.

The authors of the report admit it was ‘very unlikely’ GP performance was this low in reality – particularly as performance for the individual indicators was over 90% - but it gives ministers more ammunition to push through changes to the diabetes points in QOF.

Pulse revealed in July 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.

The composite indicator would include current indicators for measurement of HbA1c, cholesterol, blood pressure and foot checks, in an attempt to boost achievement in the routine assessment of patients with diabetes.

This proposal has been condemned by the GPC as ‘demotivating’ for GPs, but the proposal looks almost certain to go ahead after it was backed by an influential group of MPs.

In their report, the PAC said the DH was not ‘effectively incentivising delivery of all aspects of its recommended standards of care through the payments systems’.

They added: ‘GPs are paid for each individual test they carry out rather than being rewarded for ensuring all nine tests are delivered.’

The committee cited evidence from the NDA that only half of patients with diabetes were receiving all nine checks from GPs.

The DH investigation into the differences between QOF and the NDA was carried out by RCGP revalidation lead Professor Nigel Sparrow who heads up the Composite Markers Diabetes Sub Group.

It found differences in the read codes used to record the care processes for urine microalbumin, smoking and eye checks were found to largely account for the differences in results.

Professor Sparrow said the investigation showed that there had been improvements in the treatment of patients with diabetes, but that not all activity was recorded by practices.

Professor Sparrow said: ‘The report is very positive in that we can demonstrate really significant improvement in the care of patients with diabetes and the apparent differences between the NDA and QOF are due to the codes used.’

‘The 40% figure is a based on a mathematical calculation showing what is possible although very unlikely in reality.’

But Dr Bill Beeby, chair of the GPC clinical and prescribing committee, said the  40%, figure was not reliable.

He said: ‘Mathematical calculations are not reality. To base decisions on mathematical calculations that are not reality wouldn’t be very sensible.’

He added that a composite indicator would give practices a ‘perverse incentive’

He said: ‘It is not as simple as doctors telling patients what to do, people have to want to achieve it and have to be able to achieve it.

‘What you’re saying is that a practice who have done eight tests but not the ninth is retinal screening which is out of their control would not receive any reward.

Read the full report here.


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