Mental health QOF targets are intentionally difficult

GPs in England have had problems hitting quality framework targets for lithium therapy and schizophrenia indicators, figures for 2006/7 have shown.

Practices in England scored just 60.1 per cent of available points for schizophrenia, bipolar disorder and other psychoses. They scored only 83.1 per cent for treatment with lithium.

Achievement was lowest in the mental health domain, worth 39 quality points, with GPs in England achieving 91.6 per cent of mental health targets.

A similar pattern was seen across the rest of the UK. Northern Ireland scored highest with 94.6 per cent, followed by Scotland at 90.8 per cent and Wales with 86.7 per cent.

Dr Tim Saunders, GP and mental health lead for Chester West PCT, was surprised by this low level of achievement.

'The problem is due to the way data is transferred and recorded between specialists and GPs. A lot of patients on lithium are under the care of mental health specialists and not GPs', he said.

Systems needed to be put in place to aid recall, said Dr Ian Walton, West Midlands GP and chairman of Primary Care Mental Health and Education.He suggested that mental health link workers in primary care could help ensure these patients were medically reviewed by GPs.

Dr Alan Cohen, South London GP and director of primary care at the Sainsbury Centre for mental health, said the schizophrenia indicator was difficult to achieve: 'It was designed to be tough so that it makes GPs work hard to achieve the outcome. The indicator should remain in place because it is of enormous benefit to mental health patients.'

Lithium scores were likely to be low because the treatment was being used less frequently in general practice, he added.

GPC chairman Dr Laurence Buckman said that changes to the quality framework, which include the lithium therapy and schizophrenia indicators, were designed to make it harder to achieve maximum points.

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