Exclusive: GPs will be forced to conduct nine separate checks in each patient with diabetes under Department of Health plans to create a single diabetes QOF indicator worth over £5,000, Pulse can reveal.
The DH is also pushing for a change in thresholds along with the ‘composite indicator’, which would include HbA1c, cholesterol, blood pressure and foot checks, in an attempt to boost achievement in the routine assessment of patients with diabetes.
The move comes after a national audit suggested only half of patients with diabetes were receiving all nine checks – a result described as ‘appalling’ by patient groups.
But the findings of the National Diabetes Audit for 2010/11, published last month, have been plunged into controversy after the GPC filed a complaint over the data used in the audit.
The DH has launched an investigation into the GPC’s complaint, which is due to report in September. In the meantime, it has written to NICE, asking it to look at bundling all the nine checks – currently separate indicators worth 39 points (equivalent to £5,217 per year for an average practice) – into one single indicator.
NHS medical director Sir Bruce Keogh wrote to NICE last month asking it to consider ‘replacing the current QOF indicators relating to the nine processes for diabetes with a composite indicator measuring the proportion of patients who received all nine of the processes’.
In the letter, he also asked NICE to review ‘the range of target measurements and associated payment thresholds’.
If successful, the new indicator could be included in the 2015 QOF.
But GPs warned the changes could mean much more work for practices and potentially lost income, and the GPC said the profession was being ‘unfairly criticised’ because of the National Diabetes Audit’s findings.
Dr Bill Beeby, chair of the GPC’s clinical and prescribing subcommittee, told Pulse the figures from the national audit were ‘incomparable’ to the achievement recorded in the QOF: ‘GPs are not putting in the codes that the National Diabetes Audit looks for, because they’re not being asked to.
‘If you look for the wrong thing you won’t find it. Some areas are being unfairly criticised as a result.’
GPC negotiator Dr Beth McCarron-Nash said the proposed changes would be considered as part of the normal negotiation process, but added: ‘GPs asked for stability in the QOF and we are mindful of that.’
Dr Stephen Mann, a GP in Stourbridge in the West Midlands, said the change could have a drastic impact on practice income, with the increased number of checks likely to hit uptake: ‘You’ll get patients who won’t comply, won’t turn up, won’t want to be monitored.
‘GPs will have to jump through hoops, and if they miss one thing they’ll fail.’
Dr Paul Conley, a GP in Basingstoke, said: ‘GPs ensure high-level care for patients with diabetes already, and we’ve had so many changes to the QOF. This extreme micromanaging of complex clinical processes can have the opposite effect, and GPs feel demoralised.’
A spokesperson for the DH said: ‘We hope to work together [with NICE] and with the BMA and other stakeholders to improve the QOF and support ongoing improvements in quality and outcomes for patients.’
Good or bad for diabetes management?