The big one is hypertension diagnosis following ABPM. This is likely to involve a major capital investment in practices and take significant time from both practices and patients.
This will need a fairly hefty number of points to be worthwhile, although it is likely to be easier for larger practices as they will use the machine more. Smaller practices may be able to share a machine (either via a shared service or having the machine alternate weeks). Also there will be a fair bit of wear and tear on a machine that is attached to patients day and night.
If the diagnosis is not confirmed by the ABPM machine, then there will be no payment, and it would be a pity if patients were not diagnosed and treated because the diagnostic hurdles were too high.
The increase in blood pressure targets for peripheral arterial disease/CHD/stroke is bringing these areas in line with other hypertension targets (as changed for 2013/14). There has been concern from the GPC that pushing down the systolic threshold will lead to more falls and, possibly, more bone fractures. These patients, in particular stroke patients, are likely to be frailer and have mobility problems in the first place.
Lowering achievement thresholds will help, but the medium-term policy is to set the upper threshold at the level of the top quarter of practices so there will be inevitable upward pressure.
The two dementia indicators (recording a carer and attending memory clinic) are included in the dementia DES specification this year, although they do not have specific amounts of money attached. Success will depend on the availability of local memory assessment services.
How carers are defined and how practices will be expected to deal with this indicator when patients are in a care home (without a specifically named carer) will hopefully become clearer soon.
Dr Gavin Jamie is a GP in Swindon, Wiltshire, and runs the QOF Database website