GP contract praised for including individualised diabetes care
The new GP contract has been praised for factoring in frailty and individualised diabetes care.
Dr Partha Kar, NHS England’s Associate National Director for diabetes and Consultant Endocrinologist at Portsmouth Hospitals NHS Trust has said he is “delighted” that frailty and individualised diabetes cares has been addressed.
The Investment and Evolution: A five-year framework for GP contract reform to implement the NHS Long Term Plan document was released on January 31 and lays out a five-year framework for the GP services contract. Direction for primary care across the 10 ten years was also covered.
One of the main changes under the GP contract for 2019/20 sees adjustments to QOF, which will see the removal of ‘unnecessary indicators’ and introduce a new quality improvement domain.
These new indicators will also be introduced for type 2 diabetes that will see glucose targets set for younger people to avoid under-treatment and older people will no longer require intensive glucose-lowering therapy, with clinical judgement used to ascertain their required level of therapy.
Hypertension will also see changes, with the HYP003 indicator will be reintroduced that sees people under 79 controlled to 140/90mmHg, and targets extended to patients with coronary heart disease and stroke/TIA.
Dr Kar said: “This has been culmination of months of close working of the NHSE Diabetes team with the BMA GP group and we are delighted that an important issue of frailty is being looked into, with focus on individualised diabetes care, rather than a non-evidence based target driven culture. We hope this will help with issues of safety and avoid pitfalls of over treatment.
“A special word of thanks to Dr David Strain, Senior Clinical Lecturer at the University of Exeter Medical School and Dr Andrew Green, UK Clinical and Prescribing Policy Lead and BMA Council member, for their hard work in making this come to life.”
A key figure in the evolution of the relationship between frailty and diabetes care in the UK and globally has been Professor Alan Sinclair, of Diabetes Frail, who also holds a Visiting Chair in Diabetes Care at King’s College, London and a Honorary Chair in Metabolic Medicine at Aston. Professor Sinclair led the International Working Group on the Management of Frailty in Diabetes, and recently co-led, coordinated, working groups on frailty and diabetes for the JBDS and ABCD organisations. Professor Sinclair was also senior author on the important paper by Dr David Strain and colleagues that described the framework for introducing frailty assessment in diabetes into primary care that was published last year in the journal, Diabetic Medicine.
The alterations to QOF will also see exception reporting undergo an overhaul, called the personalised care adjustment, with practices able to differentiate between five different reasons for removing a patients from an indicator.
Practices will be able to choose from one of the following:
- Treatment unsuitable for the patient
- Patient chose not to have treatment following a conversation with the nurse
- The patient didn’t respond to offers of care
- Service not available
- Patient is newly diagnosed or newly registered.
To view the document, click here. The main diabetes content can be found on P61.
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