The truth about your GP’s targets for your diabetes

Doctor waiting for a patientOK, so you’ve been diagnosed with diabetes. It might be a scary time, or you might be able to emotionally take it in your stride, but one thing’s for sure – there’s lots of new information and terminology to get to grips with.

The one that I would like to bring to your attention today is QOF. This is a quality framework that sets targets for your GP. 10% of the targets relate to diabetes – setting out what your GP has to do to attract government funding for the surgery.

Not enough GPs are meeting those targets, and the NHS is looking to “impose strict incentives” according to this article. Hold it right there!! What do they mean “strict incentives”? Isn’t an incentive something nice or attractive that is used to motivate you? So what is the point of the word “strict” when used together with “incentive”? If the NHS isn’t satisfied with the level of GP focus on diabetes, then shouldn’t it be looking to impose “strict penalties” instead? But that rant is just a little aside today really!

With so many GPs apparently failing to meet their QOF targets for diabetes care, you might be forgiven for thinking that they are really tough targets to meet? I encountered the QOF targets at close quarters recently, an was appalled to find that GPs are financially incentivised by the NHS to achieve what I would consider to be the bare minimum in care. Take a look at the table in this report, which defines what different HbA1c reading mean:

“Targets for HbA1c are as follows:

  • For people without diabetes, the range is 20-41 mmol/mol
    (4-5.9%)
  • For people with diabetes, an HbA1c level of 48 mmol/mol
    (6.5%)
     is considered good control, although some people may prefer their numbers to be closer to that of non-diabetics
  • For people at greater risk of hypoglycemia (lower than normal blood sugar), a target HbA1c of 59 mmol/mol (7.5%) to reduce the risk of hypos”

So – what HbA1c reading do you think the QOF targets expect your GP to help you reach? 41 -42? Maybe 48, which is considered to show good control? Actually, 59 is the lowest HbA1c reading your GP has to hit to be paid his maximum incentive by the NHS. Shockingly, all your GP has to do is help you to fall below being “at greater risk” of hypos, and he gets maximum NHS funding for the year. Even more shockingly – your GP will receive a percentage of funding if your HbA1c is below a whopping 75! Take a look for yourself: see targets DM007, DM008 and DM009.

When your GP tells you that you are doing well, check exactly what he means by that. Is your diabetes control where you would want it to be? Is it somewhere between 42 and 48, showing good control? Or does he mean that you are doing well against his QOF targets? Am I just being over-cynical here? I wish that were the case, but I see so many people in my clinical work who are being told that they are doing well with HbA1c readings way above what they would probably want them to be if only the understood what they meant.

So GPs are failing to provide the most basic level of checks? And the NHS is planning to further incentivise them by bundling checks together? I guess it’s a start that the NHS might be noticing that diabetes care is far from acceptable. But even if your GP meets all the QOF targets, YOUR care will still be far from what RebalanceDiabetes thinks is acceptable! Our clients, time and time again, achieve HbA1c readings in the 40s, quickly and easily. Now that’s a target I bet QOF don’t dare to set but unless they do YOU are being failed by the system!

A preview of more QOF-related blog posts coming this way soon:

Think you have a choice in your healthcare? Take a look at DM010 to see why your GP will pressurise you to have your flu jab: that’s right – whatever your own view about the safety or efficacy of the flu jab, your GP will attract funding if you can be persuaded to have one!

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