England’s local medical committees want GPs to be judged against ‘good enough’ standards rather than NICE’s ‘unrealistic gold standards’.
In a motion which passed comfortably at the England LMCs conference yesterday, GP leaders asserted that current NICE guidance is ‘out of touch with the reality of working in general practice’.
They called for professional and clinical standards to instead be ‘aligned to current workforce and workload capacity’.
West Pennine LMC secretary Dr Alan Dow, who spoke in favour of the motion, told Pulse that GPs are being judged on ‘completely unfair and unrealistic standards’ – and they are ‘funded to a bronze level of care’ but ‘expected to deliver gold level standards’.
Dr Dow, who is also a BMA GP Committee member, said: ‘I’m not at all saying we shouldn’t be evidence-based, we should be evidence based.
‘But the problem with NICE is that it’s writing things for the few and not the many. And each time it makes a pronouncement, secretly, and stealthily, it’s taking away from the many to fund the few. And that resource is not just time, it’s money.’
He also said NICE guidance is ‘becoming increasingly irrelevant to direct primary care assessments’ and is instead delivering ‘very specialist’ recommendations.
‘Each time it does that, it’s actually taking money out of primary care and putting it into specialist care, and that’s a harm because actually, most people are looked after in primary care,’ Dr Dow added.
The motion, proposed by Dr Simon Wright from Dorset LMC, also said that the GMC and NHS England should not assess GPs on NICE guidelines.
Yesterday, England’s local GP leaders voted in favour abolishing the APMS contract and called for general practice waiting lists to be established.
However, they voted down a motion calling for an end to local enhanced services.
GPC England chair Dr Katie Bramall-Stainer opened the conference yesterday by telling GPs they should be thinking of capping their workload and highlighting that they have ‘never delivered more phenomenal value for money’.
Last week, NICE recommended cognitive behavioural therapy (CBT) as a treatment option for menopause symptoms – this came shortly after a Government minister revealed that GPs could be mandated to screen women for menopause within the NHS health check as well as via QOF.
Motion in full
DORSET: That conference applauds the aspiration for clinical excellence across the NHS but believes:
(i) that NICE guidance is often out of touch with the reality of working in general practice
(ii) in the current climate practitioners should be judged against ‘good enough’ rather than unrealistic ‘gold standards’
(iii) that the GMC and NHS Performance teams should not be judging practitioner performance against NICE guidelines
(iv) that GPC England should lobby for professional and clinical standards to be aligned to current workforce and workload capacity.
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READERS' COMMENTS [6]
Please note, only GPs are permitted to add comments to articles
Bears s++t in the woods as well.
Not a Bronze level service. More like fragile copper level service funding and expecting platinum level +++. They are becoming a jobke but the lawyers are loving it. Everytime we don’t follow up anybody with depression every two weeks, they win. Everytime.
Increasingly the service resembles the fake bronze of zinc “spelter” figures, wearing thin and prone to corrosion.
Dear All,
Isn’t it true that 75% of NICE guidance intended for general practice has no research evidence from general practice. I recently looked at the Hair Loss guidance, not a single paper used as evidence was based on primary care, all secondary care data.
Regards
Paul C
The under representation of General Practice in all the NICE processes is a fundamental methodological flaw, from subject selection, data provision, analysis, drafting, consultation and final report writing. This is not just in terms of determining what is “best practice”, but then determining how “best practice” might be implimented, sustainably, in the real world. Which is why any audit of patient care against established NICE guidance reveals its impact to have been minimal. It is NICE, rather then GPs, individually or collectively, who should be most judged on the implimentation of NICE guidance.
In the meantime, we need a clear mechanism through the RCGP and/or the GPC to monitor NICE activities from the conception of each project, to ensure that appropriate and sufficient (more) GP input is recruited sooner rather than later, and at every stage of their processes.
But most of all, if NICE is to persist, would it not help to have grass roots clinicians in its senior hierachy to bring its erudite and high flying leadership back down to earth.
https://www.nice.org.uk/about/who-we-are/board
Very well said Alan