GPC warns of 'target culture' as GP commissioning framework revealed

A scheme to assess clinical commissioning on 120 new measures will perpetuate 'target culture' in the NHS and could harm patients, the GPC has warned.

Dr Vautrey: ‘If COF is linked to quality premium it'll seriously undermine doctor-patient relationship and widen health inequality.’
Dr Vautrey: ‘If COF is linked to quality premium it'll seriously undermine doctor-patient relationship and widen health inequality.’

Proposals for the first Commissioning Outcomes Framework (COF) to judge clinical commissioning were published by NICE on Wednesday.

GPC deputy chairman Dr Richard Vautrey told GP the measures if adopted would be a continuation of ‘target culture' in the NHS - despite the government's warning about such tactics when in opposition.

He said this could ‘lead to patients suffering serious side effects’.

Dr Vautrey also warned that the targets must not be linked to the ‘quality premium’ – a proposed bonus payment to clinical commissioning groups (CCGs) for high quality commissioning.

He later wrote on Twitter: ‘If COF is linked to quality premium it'll seriously undermine doctor-patient relationship and widen health inequality.’

But new targets for dementia prescribing were welcomed by a charity.

CCGs will be held to account by the NHS Commissioning Board if the Health Bill successfully passes through parliament.

NICE was handed the responsibility for designing indicators for the framework and has now published its proposals.

CCGs will be expected to improve health outcomes across many areas of care, from cancer survival rates to diabetes complications.

Some are drawn from the NHS Outcomes Framework. Others were created from NICE's quality standards and guidelines.

Primary care-relevant indicators include referral to rehabilitation schemes, physical checks for patients with mental illness and patient experience of GP out-of-hours services.

Emergency admissions feature heavily, a nod to the ongoing work to cut hospital costs as part of the Quality, Innovation, Productivity and Prevention (QIPP) programme.

But some indicators appear to fall outside NHS control, such as measuring employment levels among people with long term conditions.

Patient reported outcome measures (PROMs), previously criticised by the GPC as 'simplistic', will be used to judge patient experience of care.

The COF indicators are likely to be carefully scrutinised as achievement will directly affect practice income. The BMA has promised a response in time.

High quality commissioning will be rewarded through a quality premium payment to CCGs, which could be paid out to member practices. But failure to improve the outcomes measured by the framework could mean practices lose funds.

Dr Vautrey told GP: ‘It is strange that the government which, when in opposition raised serious concerns about the previous government's target culture and the way that led to adverse unintended consequences, [is] now proposing to use an even bigger number of targets for CCGs.

‘Targets are often set with the best of intentions but the unintended consequences can lead to patients suffering serious side-effects.'

He added: ‘This is all the more reason why the COF must not be linked to financial rewards or a quality premium for CCGs.’

A DH spokesman said: ‘Far from promoting a "target culture", the COF will measure progress in improving health outcomes and patient experience and will help drive up quality of care for patients.’

A spokeswoman for the Alzheimer’s Society welcomed the inclusion of targets for reducing antipsychotic prescribing.

She said: ‘If this framework becomes reality it will represent real progress in the campaign to bring an end to this chemical cosh that ruins so many lives. We need to ensure these drugs are only ever a last resort.'

She added: ‘These proposals could also have a key role to play in ensuring all people with dementia get the care they need, when they need it, wherever they are. It is essential that these recommendations are carried forward and are effectively rolled out.’

There are around 140,000 people with dementia unnecessarily prescribed antipsychotics. The drugs are responsible for 1,800 deaths a year.

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