Anger at 'tick-box' NICE rules

Senior GPs have attacked 'outlandish' new NICE standards, warning that they will promote a 'tick-box' approach rather than personalised patient care.

Dr Holmes: conerns over follow-up
Dr Holmes: conerns over follow-up

The GPC said rheumatologists could be 'overloaded' by a proposed NICE standard that asks GPs to refer patients with any signs of inflammatory arthritis within 24 hours.

Meanwhile, a senior respiratory GP said new measures in asthma care were 'clumsy' and would promote 'blanket standards' over personalised medicine.

Last month, NICE published a quality standard for asthma and recently consulted on plans for rheumatoid arthritis.

The institute has published 25 quality standards to date, which are lists of best practice guidelines for GPs and the wider NHS. The advice is designed 'to drive and measure priority quality improvements'.

The asthma standard calls on GPs to see every patient who has an acute asthma exacerbation within two days of being discharged.

Somerset GP Dr Steve Holmes, education lead for the Primary Care Respiratory Society, said: 'Surely some complex patients would more appropriately be followed up in two days by a specialist or their team, and others in two weeks. Our patients are individuals, not tick boxes, and we should manage them as such.'

Dr Holmes said he would prefer patients to be taught how to use an inhaler, then sent home with medication and an informative discharge letter. Alternatively, patients should be followed up when and where it is appropriate for them, not according to a 'blanket standard'.

The proposed rheumatoid arthritis standard calls on GPs to refer any patient with signs or symptoms of inflammatory arthritis to a rheumatology service within one day.

Dr Bill Beeby, GPC prescribing subcommittee lead, said this was 'quite crazy'. 'Rheumatologists will get overloaded,' he added. 'Some of the consultations coming out of NICE are quite outlandish. There's a lot of consultations and clinical standards coming out, and they risk a lot of tick-box medicine.'

He said commissioners would have to make sure GPs hit the targets, but would struggle to keep track.

A NICE spokeswoman said the rheumatoid arthritis standard would be 'an important step' in helping the NHS deliver 'the very best care possible'. She added that NICE quality standards are 'not requirements or targets', although the NHS must consider them in planning care.

The final rheumatoid arthritis standard is expected in June.

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