GPC warns over 'unworkable' 2013/14 QOF changes

A GPC analysis of DH plans for the QOF suggests many new indicators backed by NICE are 'unworkable and impractical' in general practice.

Practices face 'increased public scrutiny' if forced to exception report huge numbers of patients.
Practices face 'increased public scrutiny' if forced to exception report huge numbers of patients.

GP leaders have said the DH's proposed new QOF indicators would cause unfeasibly high workload for practices and hinder good patient care.

It warned that practices face 'increased public scrutiny' if forced to exception report huge numbers of patients as a result of indicators requiring GPs to refer to services unavailable in certain parts of the UK.

The GPC said the QOF changes would be made 'without taking into account the detailed discussions held during 2012 between the GPC and NHS Employers'. This will cause 'huge problems for both practices and patients', it said.

The committee is meeting at BMA House in central London today.

'Unworkable in practice'
The GPC said that during negotiations it had agreed with many of NICE's recommendations that had a sound evidence base and were practical for GP practices. But it had rejected others as 'unworkable in practice' or because workload would be too great.

Its analysis showed that proposed targets for referral to rehabilitation for COPD and heart failure and to diabetes structured education - which would be worth almost £3,000 to the average practice - ignored the fact many such services are not universally available in the UK.

A DH spokesman speaking at a briefing earlier in December said practices in affected areas should exception report whole swathes of patients to combat this issue.

But the GPC warned: 'With the increased public scrutiny of practices’ annual QOF achievement, and the way the media has handled exception reporting in the past, GPC does not want to see practices forced to justify exception reporting rates inflated as a result of these changes.'

The GPC added that offering more or longer consultations to people with hypertension as proposed would skew healthcare towards some patients at others' expense and lead to unnecessary extra work for practices.

In the case of a proposed new hypertension indicator, nearly nine million GPPAQ physical activity questionnaires would need to be carried out across the UK each year, the GPC said, 'which would clearly have significant knock on effects to the rest of the service without any discernible benefit'.

The forthcoming target to aggressively pursue a BP target of 140/90 among patients under 79 risks increasing polypharmacy and possible hypotension, GP leaders said.

Extra training for GPs and diabetic nurses may be required to meet targets for diabetes dietary reviews, which may add 'significant extra costs' to practices when, the GPC argued, GPs already have the necessary skills. It also expressed concerns about indicators to be retired that cover work still needing to be funded, including CKD2, EPILEPSY6 and BP4.

The GPC will voice its concerns to the government in its response to the 12-week consultation, ending 26 February. Roadshows across England will take place in the New Year, with a GP survey to seek the profession's views on the changes.

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