Diabetes target is a 'threat to patient safety'

New QOF diabetes targets are posing a threat to patients and need to be reassessed, according to NHS Alliance GMS lead Dr David Jenner.

At the Alliance's spring conference in London last week, Dr Jenner challenged DoH director of primary care Dr David Colin-Thome on the issue.

Asked whether it could be fixed in the current financial year, Dr Colin-Thome said: 'I think the answer is no.'

The 2009/10 QOF reduced the lowest HbA1c target for patients with type-2 diabetes from 7.5 per cent to 7 per cent.

Dr Jenner told GP that diabetologists and others believe the new targets pose a risk to patients, since aggressive hypoglycaemic therapy can lead to hidden hypoglycaemia and, in frail elderly people, falls.

He pointed out that the new QOF targets were not in line with current NICE guidance.

'The QOF target is to have 50 per cent of patients with type-2 diabetes below an HbA1c of 7 per cent,' he said. Such treatment could require the addition of insulin or a dipeptidyl peptidase-IV (DPP-IV) inhibitor to therapy with metformin and sulphonylyureas.

'NICE guidance says you should aim to achieve an HbA1c of 6.5 per cent with metformin and sulphonylyureas and only add insulin or a DPP-IV inhibitor if a patient's HbA1c is over 7.5 per cent,' he said. 'And recent studies have shown the danger of aggressive treatment to lower HbA1c levels, in terms of heart risks.'

Dr Jenner said he wanted to see the QOF re-negotiated in-year to clarify how the target should be approached.

'The guidance doesn't set out which 50 per cent you should get below the target and which you shouldn't,' he said.

Patients deemed unsuitable for aggressive hypoglycaemic therapy should be coded as exceptions, he added.

tom.moberly@haymarket.com

Comment below and tell us what you think

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

GPs demand 'early warning system' as drug shortages drive up workload

GPs demand 'early warning system' as drug shortages drive up workload

GP leaders have demanded an 'early warning system' to flag up medicine supply problems...

GPs need minimum 3.2% pay rise plus plan to reverse cuts, says BMA

GPs need minimum 3.2% pay rise plus plan to reverse cuts, says BMA

Pay for all doctors should rise by a minimum of 3.2% in 2019/20, the BMA has warned...

Solution to GP workforce crisis must come before NHS reform, MPs told

Solution to GP workforce crisis must come before NHS reform, MPs told

The workforce crisis and underfunding of general practice must be tackled before...

Multimorbidity: The gap between guidelines and the reality in practice

Multimorbidity: The gap between guidelines and the reality in practice

Delivering outcome-focused care to patients with comorbidities is increasingly problematic...

Doctors 'severely let down' by pay review body, warns BMA

Doctors 'severely let down' by pay review body, warns BMA

BMA leaders have demanded changes to the review process that sets GP pay, warning...

GP appointments data reveal year-on-year rise in workload

GP appointments data reveal year-on-year rise in workload

GP practices across England delivered nearly 500,000 more appointments in November...