Row over cardiovascular targets in new GP contract
pharmafile | March 24, 2006 | News story | Research and Development |
Patient groups have condemned the new GP contract, saying it ignores a potentially life-threatening condition in tens of thousands of older patients.
First launched two years ago, the General Medical Services (GMS) contract sets targets for primary care clinicians to treat key diseases, such as heart disease, diabetes and asthma.
Clinical targets have now been updated after extensive negotiation between doctor's leaders and the government, but two patient groups have criticised the new contract for excluding peripheral artery disease (PAD) from the priority list.
The British Cardiac Patients Association (BCPA) and the Circulation Foundation say the disease affects as many as one in five people over 65, and is a major risk factor for myocardial infarction and stroke.
Research suggests that 60% of symptomatic PAD patients will die from myocardial infarction (MI), while a further 12% will die from stroke, and the charities say diagnosis and treatment of PAD should be a key priority.
The Quality and Outcomes Framework (QOF) is the part of the contract which contains clinical targets, and the charities have been lobbying the negotiating teams to shift away from 'coronary heart disease' (CHD) to the more comprehensive 'cardiovascular disease,' but have been disappointed with the outcome.
Eve Knight of the BCPA commented: "We'll go to the secretary of state for health if we have to, but we want an answer. We simply cannot understand why PAD has once again been sidelined. PAD fits all the QOF review criteria; is highlighted by the NSF for coronary heart disease as a priority for primary care; and doesn't require the allocation of new points but the reallocation of a few of those already aligned to cardiovascular disease."
Two other forms of cardiovascular disease, heart disease and stroke are included in the new contract, and the patient groups had wanted to see PAD added to the list, with some QOF points transferred from existing heart disease targets.
"If the Government truly wants to cut deaths from CHD, stroke and related diseases by at least two fifths in people under 75 by 2010, they are going the wrong way about it."
Professor Sir Peter Bell, Chairman of the Circulation Foundation, comments: "We have already seen that QOF clinical indicators can make a huge difference to practice. PAD is currently both under diagnosed and under treated. Primary care needs to be informed and motivated to deal with PAD, alongside heart disease and stroke, if we are to prevent unnecessary death and suffering."
Nine clinical areas have been added to the QOF for the first time: heart failure, palliative care, dementia, depression, chronic kidney disease, atrial fibrillation, obesity and learning disabilities.
A number of existing clinical indicators were amended: mental health, asthma, stroke and transient ischaemic attack, diabetes, chronic obstructive pulmonary disease, epilepsy, cancer and smoking.
The negotiations have been complex, with the government particularly keen on capping the cost of the contract, while doctors' leaders were focused on retaining a balance between payment and workload.
A number of new non-clinical indicators, such as a new patient satisfaction survey, have also been included after many months of discussion.
