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GPC warns ‘dangerous’ QOF indicators will compromise access to GPs

The changes to QOF are potentially ‘dangerous’ and will mean many sick patients will suffer reduced access to their GP, the GPC has warned in the first part of its official response to the Government’s consultation on the GP contract for 2013/14.

The strongly-worded response focuses on the changes proposed for QOF, and warns that they will ‘skew healthcare’ and will that the appointments lost in trying to deliver this work would outweigh their ‘marginal benefits’.

The response highlights that the single-biggest workload change would be to reward GP practices with 45 QOF points — worth around £6,000 — for achieving a target percentage of patients with hypertension aged 79 and under with blood pressure readings under a certain level.

It said the ‘heavy emphasis’ on measuring blood pressure will bring workload implications for GPs that are ‘so profound’ that other patients will suffer as a result, with risks of polypharmacy and ‘dangerous’ hypotension.

It said other indicators, such as measuring the percentage of patients with hypertension who have had an annual physical activity assessment, using a set questionnaire, would create the impression of a tick-box exercise that would undermine the doctor-patient relationship.

The letter to DH head of primary care Richard Armstrong also warned the DH against going ahead with its proposed changes to epilepsy indicators, which it said could cause many GP practices to ‘stop doing epilepsy reviews at all for the most complex patients’.

It also said the proposals that GPs should ask patients with diabetes every year whether they have erectile dysfunction, which the GPC said ‘seems unnecessarily insensitive’ and that many men will not be entitled to any prescriptions for treatment on the NHS.

GPC chair Dr Laurence Buckman wrote: ‘The appointments lost in trying to deliver this work would outweigh marginal benefits, adversely affecting patient access.

‘Using the QOF to hit such targets for a whole population risks increasing the number of patients suffering from the adverse effects of polypharmacy, including potentially dangerous hypotension.

‘We are not convinced that encouraging large numbers of healthy young people, who would otherwise not make an appointment to see their GP, to come to the practice, should be prioritised at the expense of offering enough appointments to those who are ill.’

The GPC added that it will be ‘impossible’ for some GP practices to achieve some QOF points, such as those based on referring patients to certain programmes because these are not universally available across the UK. It wrote that it ‘could support’ such indicators ‘if such availability could be ensured’.

The GPC said it decided to put in an interim response to the consultation at this stage as the changes are complex and would need to be planned before April 2013. It will submit its full response to all of the proposed contract changes by the end of the month after considering results from the BMA survey and taking grass-root GP views during a series of roadshows around England that kicked off last week.