GPC - General Practice is good for your health - 13 Jun 08

• Extract from : http://tinyurl.com/4droc4

As GPs from across the UK gathered in London today [Friday 13 June 2008] for the Annual Conference of Local Medical Committees, Dr Dean Marshall, chairman of the BMA’s Scottish General Practitioners Committee called on government to value general practice as the cornerstone of the modern NHS. He said:

• “The UK system of general practice is the envy of the Western World. It is the cornerstone of the NHS which was formed 60 years ago under the principle of providing care, free to all, from cradle to grave. Nowhere is that more true than in general practice.
• “Since 2004 and the introduction of the new contract, GPs have worked hard to adapt to the significant changes to the way they deliver patient care; they have met the government’s targets but still their hard work goes unrecognised and is under-valued.
• “For the past three years, GPs have seen no increase in their practice income which means that they are continuing to deliver a broad range of high quality services within a constricting budget. This is not practical, nor is it sensible for governments to starve general practice of much needed resources, when it has made a commitment to shift the balance of care out of hospitals and into local communities.
• “Investing in General Practice can bring great rewards for patient care. It means that family doctors can focus on preventative and anticipatory care, reducing the need for hospitalisation. In real terms this means patients having fewer heart attacks, strokes and reduced blood pressure and for the one million Scots living with a long term condition, it means their care can be managed locally.
• “I am proud of Scotland’s general practice and its ability to deliver real improvements for patients. GPs should be valued by politicians, just as we are trusted by our patients. Instead of trying to implement hair-brained, headline grabbing schemes, they should be talking to us about how we can work together to make further improvements to the service.”

The Quality and Outcomes Framework of the GP contract awards points to practices if they deliver on a range of services. These points attract financial resources into the practice. The majority of the points relate to evidence-based clinical interventions proven to benefit patients with illnesses such as diabetes, asthma and other long term conditions.

In 2007, general practice teams across Scotland achieved 97% of all clinical points available in the Quality and Outcomes Framework.

Various studies have demonstrated the improvements in outcomes for patients as a result of the introduction of QOF:

• QOF scores for asthma cover diagnosis, recording of smoking status among people with asthma and the need for regular asthma review. Asthma UK found that hospital admissions in England reduced where QOF achievement was higher Asthma UK, Asthma Divide: Inequalities in emergency care for people with asthma in England, 2007.
• Prevalence data provided by the 2004/05 QOF data identified 558,376 patients in Scotland with recorded hypertension, a condition which puts them at risk of developing cardiovascular illnesses and death. Research conducted by BMA Scotland showed that over a five year period, 820 cardiovascular events A cardiovascular event is defined as per the Framingham Study and includes angina pectoris, myocardial infarction, death from CHD, stroke, congestive heart failure, peripheral vascular disease and death from cardiovascular disease. such as heart attacks and stroke will be prevented by lowering blood pressure and controlling hypertension effectively.
• The same study also found that the QOF would also benefit the 221,581 patients in Scotland with Coronary Heart Disease and the 10,700 patients who die from ischaemic heart disease each year. By effectively lowering cholesterol levels in these patients, 326 cardiovascular events will be prevented over five years.
• Palliative care indicators in the QOF are based on a Gold Standards Framework for community palliative care which has been running since 2001. Prior to inclusion in the QOF, it was used by around one third of GP practices in England. This programme has proven to deliver improvements in care for this group of vulnerable patients. It has helped more people to die in their place of choice (56% of people would choose to die at home but only about 24% do so) Gold Standards Framework, Palliative Care and the GMS Contract Quality and Outcomes Framework, Guidance paper, Royal College of General Practitioners, 1 March 2006.
• In 2006, Chronic Kidney Disease (CKD) was introduced to the QOF. This requires GPs to set up a register of all patients over the age of 18 with stages 3-5 of the disease – this group accounts for around 5% of the population. One of the indicators is to reduce blood pressure in these patients, will delay the progression of CKD Kidney Research UK, QoF Indicators for Chronic Kidney Disease (CKD), April 2007.

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