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Study criticises care for older people

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Older patients are losing out on NHS primary care because a range of conditions affecting them are not included in the incentive payments given to GPs, warn researchers.

A team from the University of East Anglia looked at the quality of primary care given to 8,688 patients aged over 50 across 13 conditions, including heart disease, stroke, diabetes, depression and osteoarthritis.

They concluded care quality varied substantially by condition, with shortfalls most noticeable in areas associated with ‘disability and frailty’.

Patients with urinary incontinence received only 51% of the recommended care, while this was 44% for falls management and only 29% for osteoarthritis.

None of these conditions feature among the current clinical indicators included in the GP contract’s quality and outcomes framework (QOF).

However, patients with ischaemic heart disease received 83% of recommended care and smoking cessation was 74%, both of which are included.

An update to the QOF was announced in March but this included only minor changes to existing clinical areas and did not include any new conditions.

‘The shortfall in achievement of quality indicators reported here has serious implications,’ the authors said. ‘Quality for geriatric conditions was relatively poor in this study and no geriatric conditions were included in the GP contract. It is possible that inclusion of geriatric conditions in future payment for performance schemes would improve quality.’

BMJ (2008) 337: a957

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