Mental health charities and professional
groups today united to express concern that family doctors may next
year no longer have to improve support for patients with depression
under the system that rewards practices for the quality of care
The Royal College of Psychiatrists, British
Psychological Society, Centre for Mental Health, the Mental Health
Foundation, the Mental Health Providers Forum, Mind
and Rethink Mental Illness call on the Secretary of State
for Health to take action to ensure that next year’s Quality and
Outcomes Framework (QOF) for primary care continues to include
measures for how GPs support patients with depression.
The call follows the publication of an
Independent Advisory Committee from the National Institute for
Health and Clinical Excellence of its
recommendations for indicators in the QOF for 2012/13. It
concludes that the current three indicators for depression should
be retired from next year’s framework because there is not enough
evidence to support them.
Our organisations are extremely concerned
that retiring the existing indicators for depression without
replacing them with new measures of equal weight would have very
damaging consequences for people with depression. It would remove
at a stroke the main incentive for family doctors to manage the
care of patients with depression and to support the mental health
of patients with diabetes and heart disease.
We therefore welcome Sir Andrew Dillon’s
letter to the QOF Negotiators recognising that retiring the
existing indicators before replacements are ready would have
adverse consequences for patients and noting that work is already
under way to develop new indicators for depression for future
We are also encouraged that the Department
of Health has asked that in future new indicators should be
proposed before all of the indicators for a particular condition
are retired from the QOF. We hope that this approach will inform
the decision about this year’s indicators between NHS Employers and
the BMA’s General Practitioners Committee.
Professor Sue Bailey, President of the
Royal College of Psychiatrists, said: "Depression has a significant
impact on the lives of those who personally experience it, but also
the lives of their families and carers and on society as a whole.
The Quality and Outcomes Framework (QOF) not only acts as an
incentive to improve the quality of care available to those who
experience depression, but helps to shape the care that will be
available in the future. The incentive for screening for depression
in primary care, including people with long-term physical
conditions, should not only be continued, but extended under the
framework. This will ensure that doctors will be able to offer
the best quality of care to their patients both now, and in
the future, and enable doctors to work with individuals and
families to improve their mental health and emotional
John Hanna, Policy Unit Director for the
Division of Clinical Psychology at the British Psychological
Society, said: "We are astonished and disappointed that it is
proposed that the QOF indicators for depression be dropped, rather
than, as we hoped and expected, improved and replaced.
Depression negatively impacts on society at all levels and
accounts for a substantial cost to personal lives and the economy,
estimated to cost the UK many billions of pounds per year.
Losing these indicators risks a significant loss of incentive
for GPs to give focus to mental health concerns; the gap left by
these indicators could well be filled by non-mental health-focussed
incentives, further unbalancing the “parity of esteem” sought
within the mental health sector on behalf of mental health service
users and carers. We call on the independent advisory
committee to reverse this decision, and to grant time to improve
and revitalise the existing standards so that they become more
workable for GPs."
Sean Duggan, chief executive of Centre for
Mental Health said: "General practices need to be given the right
incentives to identify people who have depression, to offer them
timely and effective treatment, and to look after their physical as
well as mental health. And they need to look out for the mental
health of people with long-term physical conditions. The
Government’s mental health strategy, No Health Without Mental
Health, rightly sets out that mental health issues will be
given ‘parity of esteem’ with physical health. It also sets out
objectives to improve the mental health of people with physical
health conditions and vice versa. The Quality and Outcomes
Framework presents an early test of how these commitments will be
supported in practice."
Dr Andrew McCulloch, Chief Executive of the
Mental Health Foundation, said: "Removing QOF incentives for GPs to
identify and help patients with depression would not only represent
a significant backward step in the treatment of mental illness in
this country, but would renege on the pledge made in the
coalition’s mental health strategy to treat mental health problems
as of equal importance to physical illnesses. We’d be happy to see
informed debate about the best indicators to use, but removing them
completely from QOF would give quite the wrong message about how
important it is to ensure patients get timely and effective
treatment for depression."
Dr Ian McPherson, chief executive of the
Mental Health Providers Forum, said: "A decision simply to remove
the QOF indicators for depression, rather than reviewing or
strengthening them, would give the unfortunate message that there
is no need to incentivise the treatment of one of the most
disabling conditions in primary care for which effective
interventions are increasingly available, but which still tends not
to be as accurately identified as conditions which do not carry the
same level of social and personal discrimination."
Paul Farmer, chief executive of Mind, said:
"The government has made clear that mental health is a society wide
priority, and taking depression out of the incentive scheme for GPs
actively undermines everything the government has been working
towards to improve mental health in our country. People with
depression struggle to get the treatment they need as it is, and
removing incentives for GPs to give good treatment risks further
compromising their care. A third of all GPs case load is mental and
emotional health care – making sure this is done well is
Paul Jenkins, chief executive of Rethink
Mental Illness said: "This is an extremely worrying and
potentially damaging development. We know that people with mental
health problems already get a raw deal when it comes to access to
treatment, so removing GP’s incentives in this area makes no sense
at all. In some GP surgeries half of all patients are there because
of a mental health problem – mental illness is not a side issue,
it’s the core business of many family doctors, so it’s vital it be
Depression and anxiety affect one person in
six every year. Depression affects people of all ages and is one of
the biggest causes of lost quality of life and lost work in
Britain. Yet only a quarter of people with depression ever get any
treatment for it. Depression is also closely associated with poor
physical health and can dramatically affect people with many
serious illnesses including diabetes and heart disease.
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The National Institute for Health and Clinical Excellence (NICE) today published the recommendations of an Independent Advisory Committee over what indicators should be included in next year’s Quality and Outcomes Framework (QOF), through which general practices are rewarded according to the outcomes they achieve for their patients. The guidance will be used in negotiations between NHS Employers and the BMA’s General Practice Committee (GPC) in deciding the content of the QOF for 2012/13. NICE has also published a letter from Sir Andrew Dillon to NHS Employers and the GPC about the risks of retiring the depression indicators before replacements are ready to use.
Note to editors:
There are currently three indicators for depression within the QOF:
The percentage of patients on the diabetes and coronary heart disease registers who have been screened for depression.
The percentage of patients who have had an assessment of severity of their depression when it is first diagnosed.
The percentage of the previous group who have had a further assessment between one and three months later.
Today’s report recommends that these indicators be removed from the QOF next year as they lack evidence of their effectiveness.