Benefits Of New GP Contract To Patients Recognised In New Audit Scotland Report

Main Category: Primary Care / General Practice
Also Included In: Public Health
Article Date: 03 Jul 2008 - 1:00 PDT

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Responding to the Audit Scotland's review of the new GP contract which was published, Dr Dean Marshall, chairman of the BMA's Scottish General Practitioners Committee, welcomed the recognition that the contract would benefit patient care but warned that the 'boom and bust' approach to funding general practice was a mistake.

Dr Marshall said:

"The report is a timely reminder of the reasons why a new contract was required for general practice. GPs were struggling to manage an ever-growing workload, morale was at an all time low and recruitment and retention was becoming a significant problem as one in four GPs was considering leaving the profession. The new contract sought to resolve these issues which helped to make general practice an attractive career option once again.

"I am pleased that this report has recognised the hard work and commitment of Scotland's GPs to deliver the new contract. They have adapted quickly to the new ways of working and have achieved high levels of quality achievement within a relatively short period of time. Already patients are reaping the benefits*.

"But without better co-operation between government and GPs, these benefits may be short-lived. In the last three years, practices have seen cuts in their core funding which adversely affects the services they can provide to patients. Just as we are beginning to see the beneficial effects on patients' lives, these cuts in funding could mean that those improvements are less likely to continue."

*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 such as heart attacks and stroke will be prevented by lowering blood pressure and controlling hypertension effectively. (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.)

- 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 â€" 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).

British Medical Association