Mental health quality points prove elusive

Mental health and depression have proven the most difficult clinical targets in the quality framework to meet, figures for 2006/7 suggest.

Analysis of quality score data from Scotland, Wales and Northern Ireland for 2006/7 confirm fears that the mental health targets would prove the most difficult.

In Wales, only 73.9 per cent of depression indicators were met. For mental health, which includes patients with schizophrenia, bipolar disorder and other psychoses, just 86.7 per cent of targets were achieved.

Scotland fared slightly better, hitting 84.6 per cent of depression and 90.8 per cent of mental health targets.

Meanwhile, Northern Ireland, which achieved most quality points overall, did best on these clinical indicators. But it still only achieved 88.1 per cent of depression targets and 94.6 per cent of those for mental health.

Chairman of GPC Wales Dr David Bailey said: ‘The depression and mental health indicators are the most difficult to achieve.

‘The screening can be difficult because patients can look askance when you ask these questions and there are concerns about the effect on the doctor-patient relationship.’

GPC Scotland chairman Dr Dean Marshall said: ‘There have been issues with some of the indicators across Scotland, notably for mental health and depression and there is no doubt that that needs to be developed further.’

Nevertheless, these domains should remain in the quality framework to ensure reward for GPs ‘who make a positive difference in a very difficult, but tremendously important area of general practice,’ added Dr Marshall.

Previous complaints about the mental health domains include the concerns of GPC member Dr Trefor Roscoe who said that their complexity leads to inertia among GPs, meaning they stop trying to achieve targets.

A report submitted to the GPC last year by Wiltshire GP Dr Gavin Jamie pointed up Read Code problems.

RCGP spokeswoman Dr Sarah Jarvis said part of the problem is also that mental health patients are looked after by both primary and secondary care. This may mean that some targets are achieved, but not within the GP practice.

‘I think recording is a major issue here,’ she said.
In contrast, domains such as chronic kidney disease (CKD) are largely cared for in primary care, explaining good scores all round for these targets, added Dr Jarvis.

Scotland met 99.8 per cent of CKD indicators, Wales 98.1 per cent and Northern Ireland 99.2 per cent.

rachel.liddle@haymarket.com

Wales quality scores: http://new.wales.gov.uk/topics/statistics/headlines/health-2007/hdw200709201/?lang=enNorthern

Ireland quality scores: http://www.dhsspsni.gov.uk/index/hss/gp_contracts/gp_contract_qof/qof_data.htm

Scotland quality scores:
www.isdscotland.org/qof

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