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Proposal to drop depression from GP quality indicators sparks outcry


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BMJ 2011; 343:d5073 doi: 10.1136/bmj.d5073 (Published 8 August 2011)Cite this as: BMJ 2011; 343:d5073

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    Proposal to drop depression from GP quality indicators sparks outcry
    • Adrian O’Dowd-Author Affiliations

      • Several mental health organisations have reacted angrily to proposals that some target indicators on depression in the Quality and Outcomes Framework (QOF) for GPs in England should be dropped.

        QOF, the Department of Health’s incentive scheme that rewards GPs for how well they care for patients, is being updated, with the intention of improving the quality of care across general practice.

        The National Institute for Health and Clinical Excellence (NICE), which now leads on changes to QOF, published its proposed indicators for 2012-13 on 1 August.

        The new “menu” of 18 indicators will help target resources where they are most needed and deliver the best outcomes among patients, said NICE. Each new indicator has been piloted across a range of general practices and is based on up to date evidence, it said.

        The menu includes three new indicators on offering support and treatment for smokers; two new indicators to assess levels of physical activity and provide a brief intervention to people with high blood pressure who are assessed as being “less than active”; one indicator to improve care for people with asthma; and a set of indicators on fragility fractures in patients with osteoporosis.

        Negotiators for the BMA’s General Practitioners Committee and NHS Employers will decide on which of these final recommendations to accept for QOF in talks starting in the autumn, and a final decision will be announced in the winter.

        But NICE has also recommended removing 17 indicators from the current QOF that deal with depression, diabetes, epilepsy, and atrial fibrillation.

        NICE believes that there is not enough evidence to support the current indicators on depression, which focus on case finding and severity and which, it says, might actually be detrimental, because they oversimplify case finding in patients with long term conditions.

        Several mental health charities and professional groups have united to express concern that dropping the existing indicators for depression without replacing them with new measures of equal weight would have damaging consequences for people with depression.

        The bodies included the British Psychological Society, the Centre for Mental Health, the Mental Health Foundation, the Mental Health Providers Forum, Mind, Rethink Mental Illness, and the Royal College of Psychiatrists.

        Andrew McCulloch, chief executive of the Mental Health Foundation, said, “Removing QOF incentives for GPs to identify and help patients with depression represents a significant backward step in the treatment of mental illness in this country.”

        Paul Farmer, chief executive of the charity Mind, said, “People with depression struggle to get the treatment they need as it is, and removing incentives for GPs to give good treatment risks further compromising their care.”

        Sue Bailey, president of the Royal College of Psychiatrists, said, “The incentive for screening for depression in primary care, including people with long term physical conditions, should not only be continued but extended under the framework.”

        The NHS Confederation’s mental health network also opposes the move. Its director, Steve Shrubb, said, “Imperfect as the indicators are, our members think it would be reckless to remove the depression indicators from the GP treatment framework until suitable alternatives are in place.”

        The charity Diabetes UK also has concerns about some of the proposed changes to indicators on diabetes. Its policy manager, Gavin Terry, said, “The new, higher blood pressure target of 150/90 [mm Hg] is particularly perverse, as it could discourage GPs from proactively working with people with diabetes to decrease their blood pressure and increase the risk of complications.

        “We are also disappointed that diabetes process measures on blood glucose, blood pressure, cholesterol, and kidney functions have been removed from the QOF. It is doubtful that all these processes are so well embedded in practice that their retirement from the QOF is not a risk.”

        Christine Carson, programme director of NICE’s Centre for Clinical Practice, said that NICE had consulted widely before making its proposals.


        Cite this as: BMJ 2011;343:d5073


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