Local incentives to cut lifestyle risks

PCTs could set up local quality initiatives to reward GPs for promoting healthy lifestyles, says a DoH report.

In addition, all practice-based commissioning schemes will be expected to include a means of ‘incentivising practice-based commissioners to reduce people’s lifestyle risks’ by 2008/9.

The Commissioning Framework for Health and Wellbeing  hit the headlines last week, encouraging GPs to move into lifestyle management by prescribing ‘non-health interventions’ such as air-conditioning for COPD patients and anger management courses for children with behavioural problems (GP, 9 March).

The report calls for commissioning organisations to create ‘local financial incentives to encourage early action for those at risk from an unhealthy lifestyle and the development of person-centred care’.

Incentives could be created by PCTs, local authorities or both. The report says local authorities already have the power to create incentive schemes of this type.

Schemes that could be incentivised as part of person-centred care include devolving budgets to patients, agreeing joint health and social care plans and setting up multidisciplinary teams across health and social care, the report says.

DoH national clinical director for primary care Dr David Colin-Thomé said last year that indicators for smoking, obesity and alcohol could feature in the GMS quality framework for 2008/9 (GP, 20 October 2006).

But GPC deputy chairman Dr Laurence Buckman said he doubted there would ever be strong enough evidence to justify primary care interventions for obesity, and that the case for including alcohol measures was uncertain.

GPC negotiator Dr Stewart Drage said that if PCTs wanted to encourage practices to tackle lifestyle issues, they could do so through enhanced services.

‘It would be much quicker and easier than setting up a local quality framework,’ he said.

GPC member Dr Fay Wilson said the risk with local schemes was that there was no guarantee they would be sustained.

‘It sounds like a good idea on paper, but it won’t work because of financial constraints,’ she said.

‘As soon as the money gets tight, this is the sort of thing that will get cut.’

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