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PNs face tough new blood pressure target for diabetes

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Practice nurses face the prospect of tougher blood pressure targets for diabetes from next year.

Last week NICE revealed four clinical indicators being considered for inclusion in the GP contract’s QOF/index.htm” class=”intextlink”>Quality and Outcomes Framework from 2010–2011. These include two potential indicators for BP control in patients with diabetes.

The current version of the QOF sets a single target of a BP of 145/85mmHg for 40–60% of a practice’s patients with diabetes. But NICE’s QOF advisory committee has recommended replacing this with two new targets that reward practices in a stepped approach.

The first new indicator would see practice nurses supporting patients with diabetes to achieve a BP of 150/90mmHg – an easier target than at present. But the second new target would then see practice nurses facing a further diabetic patient BP target of 140/80mmHg – in line with NICE guidance on diabetes.

NICE has not revealed the percentage of patients needed to meet either of the new targets, or how many QOF points would be available for meeting them.

Despite the difficulty attached to meeting the 140/80mmHg target, diabetes specialist nurses have welcomed its possible inclusion. However, they argue that the easier target should not be included.

‘A higher target of 150/90mmHg gives the wrong impression to both professionals and patients of the importance of maintaining an acceptable blood pressure level in patients with diabetes,’ said Julie Widdowson, diabetes educator and practitioner at Norfolk PCT.

‘Although these are very challenging targets to meet and need a lot of medication and support, evidence has shown for a number of years that these are the targets we should be working towards,’ she added.

The proposed diabetes indicators targets form part of the first set of new QOF indicators to be produced by NICE, which took over the process of developing and managing QOF indicators in April.

A NICE spokesperson said: ‘The first indicator relates to the NICE clinical guideline for type 2 diabetes which recommends a blood pressure target of 140/80mmHg. However the advisory committee also recognised that there is evidence to show that blood pressure is sometimes difficult to control particularly in diabetic patients to this level and so felt there was some merit for including a further indicator targeting150/90mmHg. This is why two indicators have been put forward for negotiations later this month.’

The other two suggested indicators – for learning disabilities and epilepsy – are to measure and record thyroid-stimulating hormone in patients with Down’s Syndrome, and to offer information on contraception, conception and pregnancy to women with epilepsy.

NHS Employerswill now consult with the British Medical Association on which of the four possible indicators should be added to the GP contract from next April.

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