Quality framework 'harms' holistic care

Financial incentives improve chronic disease management, but potentially to the detriment of holistic care, according to a study of Norfolk practices.

Researchers looked at four specific indicators of care in 18 practices: one each for hypertension and asthma, from the quality framework, the other two, derived using a variety of sources including NICE guidance, were for osteoarthritis and depression.

Achievement of the quality framework indicators increased from 75 per cent in 2003 to 91 per cent in 2005. In contrast, there was minimal improvement in the non-quality framework indicators, from 35 to 36 per cent. Furthermore, the researchers noted that certain aspects of care for quality framework conditions that were not covered by a specific indicator also improved.

Dr Nicholas Steel, senior lecturer in primary care at the University of East Anglia, presenting the results at the RCGP conference in Edinburgh, said there had been a big improvement in the management of conditions incentivised under the quality framework and that chronic disease management was now very well organised in the UK. But he added that conditions not included in the quality framework remained a low priority and that GPs might be missing out on the holistic aspect of their care.


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