People with depression could face “damaging consequences” from “reckless” plans to remove three performance indicators designed to encourage GPs to identify and treat people with the condition.
Charities, professional groups and provider leaders have warned that removing the indicators from the Quality and Outcomes Framework for GPs without putting replacements in their place would “remove at a stroke the main incentive for family doctors to manage the care of patients with depression”.
The QOF rewards GP practices for performance against a set of indicators. In proposals published today, the National Institute for Health and Clinical Excellence recommended the removal of the three depression indicators, which concern:
• Identifying diabetes or coronary heart disease patients with depression.
• Assessing the severity of depression for patients with a new diagnosis of the condition.
• Carrying out a further assessment of severity within 12 weeks of the initial assessment.
Nice’s independent advisory committee on the QOF concluded that there was a lack of evidence that the indicators improved outcomes and that GPs had concerns that they were over-bureaucratic.
However, the decision to scrap them without having replacements in place was slammed.
“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,” said Steve Shrubb, director of the Mental Health Network, which represents most mental health trusts.
“Experience also suggests that it will be very hard to get indicators on depression back into the outcomes framework once removed. We believe the indicators should be left in place until suitable alternatives are available.”
His concerns were echoed by the British Psychological Society, the Centre for Mental Health, the Mental Health Foundation, the Mental Health Providers Forum, Mind, Rethink and the Royal College of Psychiatrists.
“A decision simply to remove the QOF indicators, rather than reviewing or strengthening them would give the unfortunate message that there is no need to incentivise the treatment of one of the most disabling conditions in primary care for which effective interventions are increasingly available, but which still tends not to be as accurately identified as conditiosn which do not carry the same level of social and personal discrimination,” said Dr Ian McPherson, chief executive of the providers forum and former head of the government’s National Mental Health Development Unit.
The proposals from Nice will now be subject to negotiation between NHS Employers and the General Practitioners Committee of the British Medical Association, who will decide on the final indicators for 2012-13.
In a letter to the negotiators, Nice chief executive Andrew Dillon said the institute was looking at developing some fresh depression indicators. But he warned that removing the depression indicators without replacing them may reduce quality of care, saying this was something for the negotiators to reflect on.
In future, indicators for specific diseases will not be scrapped in their entirety without replacements having been developed.
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