NICE CG127: Implementation in Primary care Dr Terry McCormack, Whitby.

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Presentation transcript:

NICE CG127: Implementation in Primary care Dr Terry McCormack, Whitby

Will GPs follow the Guidance? NICE CG NICE CG NICE CG ?

Will GPs follow the Guidance? NICE CG NICE CG NICE CG ?

Will GPs follow the Guidance? NICE CG NICE CG NICE CG ? Professionalism? Incentives – QOF?

Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study: Serumaga, B et al. BMJ 2011 THIN database ( The Health Improvement Network 358/470,725) January 2000 to August 2007 QOF introduced April 2004 Using G20 code x2 Centiles systolic/diastolic BP over time Number of measurements performed Blood pressure control Treatment intensity Cardiovascular outcomes BMJ 2011; 342:d108 doi: /bmj.d108 (Published 25 January 2011)

Fig 1 Time series of centiles of systolic and diastolic blood pressure in United Kingdom by quarter from January 2001 to July Serumaga B et al. BMJ 2011;342:bmj.d108 ©2011 by British Medical Journal Publishing Group

Fig 2 Effect of pay for performance on blood pressure control and monitoring in United Kingdom. ©2011 by British Medical Journal Publishing Group Serumaga B et al. BMJ 2011;342:bmj.d108

Fig 3 Effect of pay for performance on intensity of treatment for hypertension in United Kingdom. ©2011 by British Medical Journal Publishing Group Serumaga B et al. BMJ 2011;342:bmj.d108

Fig 4 Effect of pay for performance on hypertension related adverse outcomes (myocardial infarction, stroke, renal failure, heart failure) or on all cause mortality in United Kingdom. ©2011 by British Medical Journal Publishing Group Serumaga B et al. BMJ 2011;342:bmj.d108

Results/Conclusion No change in activity No change in outcomes Pay for performance had no effect NICE - CG may have influenced GP performance

Limitations EMIS practices – sociodemographic population but ?higher performance GPs G20 code = those we intend to treat and try hard (excludes many TOD patients) Code cleaning was taking place No measure of exception reporting Too soon to see change Short period for outcomes study

Interpretation Professionalism won over incentivisation GPs already applying a better standard? Influence of NICE guideline 2004? Many practices will have been trying to get ahead of the game For many QOF meant recording what we did, poorer practices had to change the most Needs updating

Quality Outcomes Framework

NICE CG ? Have we changed and become ruled by QOF? Treatment algorithm logical and easy to apply Spironolactone requires a leaflet advising care when dehydrated or suffering diarrhoea/vomiting Advice to treat over 80s will challenge some doctors preconceptions ABPM is the biggest hurdle Capital cost Logistics Mindset change from repeat visits/measurements

New QOF hypertension target pilot As a result of a letter from BHS Executive Target remains at 150/90 for those aged 80 or more Lower targets remain for CKD, Diabetes BPThreshold 150/9090% 140/9050%