Exclusive: GPs reject 'bundled' QOF diabetes plan

Most GPs oppose a plan to bundle eight diabetes checks into one QOF indicator in next year's contract, a GP survey reveals, as a senior figure warns it could harm the patient-doctor relationship.

Foot examination: QOF measure to bundle diabetes checks opposed by GPs (Photo: iStock)
Foot examination: QOF measure to bundle diabetes checks opposed by GPs (Photo: iStock)

Two-thirds (64%) of 635 GPs in the survey rejected the new ‘eight-in-one’ indicator, which has been proposed by NICE as an option to negotiators.

The GPC said the step would be ‘counterproductive’ to patient care, while other GPs warned it could be used as an excuse to strip practices of income.

NICE advisors approved the composite QOF indicator last month, despite warnings from pilot practices that it was ‘unreasonable'.

The eight measures were recommended as separate indicators, but with the option for negotiators to aggregate them into one bundled indicator.

If this option were taken, the indicator would pay out only if eight separate checks were performed for each diabetes patient on the practice list. The tests are: BMI, BP, HbA1c, cholesterol, albumin:creatinine ratio and serum creatinine, as well as smoking status and foot examination.

'Disproportionate'

GPC chairman Dr Nagpaul said resistance to the indicator was ‘unsurprising’, and said he saw no reason to bundle the indicators together.

He said: ‘Having an indicator which requires an all-or-nothing approach to individual components could be counterproductive. GPs may achieve some components and not achieve others, and I think there are real concerns around lumping a range of parameters into a single payment indicator.’

Surrey GP Dr Neil Munro, former chairman of Primary Care Diabetes Europe, warned practices could be ‘heavily penalised’ if a patient refuses just one test. ‘This has the potential to interfere significantly with relationships between patients and practices and seems disproportionate to the possible gain.’

'Setting GPs up to fail'

Norfolk GP Dr Martin Hadley-Brown, former chair of the Primary Care Diabetes Society, said: ‘I'm not convinced that it's a particularly good idea. When the piloting practices report significant problems with this composite indicator, one might hope that note would be taken of that.’

He questioned the lack of retinal screening in the indicator, and said he feared a composite measure may be an opportunity to offer fewer points than separate indicators.

Many of those surveyed said it would ‘set GPs up to fail’ because of patients’ ‘unwillingness’ to attend surgery, a factor outside their control.

The poll also revealed declining support for the QOF, with 55% saying they would support further reduction in the 2015/16 contract. One respondent said: ‘It detracts from patient care and spoils the consultation’.

NICE had yet to respond to a request for comment at the time of publication.

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