Exclusive: GP pay to reflect adherence to NICE

GPs warn patients could suffer as NICE advice reshapes quality framework.

GPs could be made to follow NICE guidance or risk losing income under the quality framework.

Speaking exclusively to GP, Professor Sir Michael Rawlins, chairman of NICE, said the institute had decided to become involved in the development of the quality framework in an attempt to get more GPs to follow its guidance.

'What we want is to ensure that our guidance is taken up and used appropriately. The quality framework is one route into implementing the guidance.'

Currently, GPs are not incentivised to carry out NICE guidance and can choose to follow or ignore it.

But under proposals announced this summer by health minister Lord Ara Darzi, NICE will become involved in developing and selecting the clinical indicators for the quality framework.

Changes to the quality framework for 2009/10 have already seen it incorporate NICE guidance on the use of long-acting reversible contraceptives.

Dr Sarah Jarvis, a GP in West London and a spokeswoman for the RCGP, warned that it would be a 'disaster' to have NICE indicators in the framework.

'It is extremely worrying as NICE is supposed to be about guidance, not protocol.

'It should be down to GPs to use their own clinical judgment as to whether they use NICE guidance or not.'

NICE 'hides behind the facade' of doing what is best for patients, but its real concern is cost-effectiveness, added Dr Jarvis.

'Many GPs who are not as certain of the clinical evidence will follow NICE guidance and this will lead to patients suffering,' she warned.

GPC deputy chairman Dr Richard Vautrey, said: 'NICE guidance does not apply for the whole of the UK, so this is something that will need to be looked at carefully.

'But as long as the NICE guidance has validity and fits in with routine general practice then GPs will follow it.'

Sir Michael played down fears that NICE's involvement in the framework would lead to a radical overhaul.

'It's an evolutionary approach, it's about not sticking in permafrost for the next 25 years but to evolve as problems emerge or disappear,' he said.

sanjay.tanday@haymarket.com

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