31 July 2012
Drop Them And QOF!
We recently described the findings of the National Diabetes Audit report which were at odds with GMS QOF statistics. The fallout has reached the most exalted peaks; even landing in the medical equivalent of Valhalla, namely the GMS QOF / NICE headquarters.
NICE are suggesting that, as from 2015, nine diabetes criteria, at present accounting for 39 points, will be lumped together into one. This would include such things as HbA1C, blood pressure, cholesterol and foot checks.
Quite how having one large criterium rather than nine smaller ones would affect the discrepancy between what GP’s claim for under QOF and the figures recorded in the diabetes audit is difficult to see. Nevertheless some feathers have been ruffled.
The General Practice Committee of the BMA decided to attack the messenger rather than the message. For some reason, the methods of the National Diabetes Audit were supposed to account for the huge difference between its findings and what was being claimed under GMS QOF. A complaint has been issued. It seems rather like the Government criticising the fact of a leak rather than having to answer to what the leak exposes.
One thing is quite clear is the integrity of the National Diabetes Audit. The fact that the chairman is Professor Bob Young should be sufficient to guarantee that.
One GP commented, “the change could have a drastic impact on practice income, with the increased number of checks likely to hit uptake.” What increased checks?
“GP’s will have to jump through hoops, and if they miss one thing, they’ll fail.” Just like now.
“GP’s warned that the changes could mean much more work for practices and potentially lost income.” You mean that in future, GP’s won’t get paid for work that they are not doing?
But enough of this quibbling. The clustering of the criteria carries an important message about the whole philosophy of Diabetes management, which is that treating diabetes is not just about glycæmic control. It is not just about blood pressure management. It is not just about cholesterol control and so on. It is about all of the nine parameters of a clinical continuum, and each parameter is equally (or almost equally) important.
It is all very well having an HbA1C of 45 mmol/mol but if your blood pressure is 200/160, your name is still on the bomb.
When GMS QOF was first introduced, there was some criticism of the rationale in that small criteria could obscure the global picture. NICE is now attempting to address this. Maybe, if it is successful, this trend will be extended to other chronic diseases.
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