How much are you worth?

Baruney

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928
Type of diabetes
Type 2
Treatment type
Diet only
Hola

Does anybody know or could point me in the right direction in regards to finding out how much extra funding a gp gets when someone is diagnosed as diabetic?

Also is it tiered or across the board? Eg would someone on insulin or diabetic drugs have a higher funding level than someone on diet and exercise. Or t1/t2 etc etc

And while we are at it - is that funding Dependent on you completing your minimum diabetic care standards for eg at least one blood test per year, eye screen etc.

Cheers.
 
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18,448
Type of diabetes
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Morning, I personally don't know the costs, but found this information online :-
Are the financial incentives given to UK doctors regarding diabetes doing more harm than good?
by Dr John Briffa on 13 March 2009 in Diabetes/Metabolic Syndrome, Food and Medical Politics
Diabetes is a condition characterised by higher-than-normal levels of sugar (glucose) in the bloodstream. One problem here is that there is more tendency for glucose to react with proteins and fats in the body (through a process known as glycation) that can damage tissues. The complications of diabetes, including nerve, vessel, eye and kidney damage, generally have their roots in glycation.

So, it makes sense then keeping blood sugar levels in check should help to prevent the complications of diabetes. So important is this deemed to be, that the UK government gives general practitioners (GPs) money to ‘incentivise’ them to assist their patients in achieving relatively tight control over their blood sugar levels. From April of this year, if GPs can get half of their type 2 diabetic patients to have a HbA1c level (this is a measure of blood sugar control over the preceding 3 months or so) of less than 7 per cent, then the practice gets an additional payment of £3000 ($4250). Prior to this, the target set by the government was 7.5 per cent. Clearly, the government feels that when it comes to HbA1c levels, lower is better.

I imagine that not everyone will be comfortable with the notion of doctors being financially incentivised to treat patients in a way deemed appropriate by their government. But, these individuals at least can take comfort in the fact that the government’s strategy is ‘evidence-based’. However, as a recent piece in the British Medical Journal [1] points out, this is far from assured.

In this piece, the authors (one a UK GP and the other a professor of medicine, epidemiology and public health in the USA) detail the results of three recent studies which suggest that tighter control of blood sugar by pharmacological means may not be such a good idea. One of these trials [2] I reported on here. It showed a higher mortality rate in individuals who were more intensively treated. The other two studies cited [3,4] showed little or no differences in outcomes.

All of the studies found intensive treatment to be associated with an increased risk of hypoglycaemia (low blood sugar). The authors summarise the findings of these three studies thus: Taken together, the three trials show that no reduction of clinically meaningful adverse outcomes occurred in patients with long standing type 2 diabetes treated to a glycated haemoglobin below 7.0% in the time periods studied. Moreover, intensive treatment is accompanied by substantial costs and an increased risk of hypoglycaemia and perhaps mortality.

The authors point out that these studies were done in older individuals (mean age 60+) with quite long-standing illness. There is some evidence that more intensive therapy in younger individuals (mean age 54) with newly diagnosed diabetes [5]. Nevertheless, the authors argue, the current state of the evidence gives us enough reason to reconsider the conventional wisdom regarding blood sugar control in type 2 diabetes.

They bring up another interesting point too, when they question whether all strategies that reduce HbA1c levels have the same effect. Even for a given level of blood sugar lowering effect, different drugs or combinations of drugs may have very different effects on the outcomes that matter (like risk of disease and death). As they point out, our knowledge in this area is quite unsatisfactory.

It seems that not only is the UK government’s recent move to lower the HbA1c targets for GPs not particularly evidence-based, there is a risk it might actually do more harm than good. The authors of the BMJ piece use some good old-fashioned plain-speak to conclude their piece by stating: The change of target from 7.5% to 7% should be withdrawn before it wastes resources and possibly harms patients.

Best wishes RRB
 
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Baruney

BANNED
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928
Type of diabetes
Type 2
Treatment type
Diet only
Morning, I personally don't know the costs, but found this information online :-
Are the financial incentives given to UK doctors regarding diabetes doing more harm than good?
by Dr John Briffa on 13 March 2009 in Diabetes/Metabolic Syndrome, Food and Medical Politics
Diabetes is a condition characterised by higher-than-normal levels of sugar (glucose) in the bloodstream. One problem here is that there is more tendency for glucose to react with proteins and fats in the body (through a process known as glycation) that can damage tissues. The complications of diabetes, including nerve, vessel, eye and kidney damage, generally have their roots in glycation.

So, it makes sense then keeping blood sugar levels in check should help to prevent the complications of diabetes. So important is this deemed to be, that the UK government gives general practitioners (GPs) money to ‘incentivise’ them to assist their patients in achieving relatively tight control over their blood sugar levels. From April of this year, if GPs can get half of their type 2 diabetic patients to have a HbA1c level (this is a measure of blood sugar control over the preceding 3 months or so) of less than 7 per cent, then the practice gets an additional payment of £3000 ($4250). Prior to this, the target set by the government was 7.5 per cent. Clearly, the government feels that when it comes to HbA1c levels, lower is better.

I imagine that not everyone will be comfortable with the notion of doctors being financially incentivised to treat patients in a way deemed appropriate by their government. But, these individuals at least can take comfort in the fact that the government’s strategy is ‘evidence-based’. However, as a recent piece in the British Medical Journal [1] points out, this is far from assured.

In this piece, the authors (one a UK GP and the other a professor of medicine, epidemiology and public health in the USA) detail the results of three recent studies which suggest that tighter control of blood sugar by pharmacological means may not be such a good idea. One of these trials [2] I reported on here. It showed a higher mortality rate in individuals who were more intensively treated. The other two studies cited [3,4] showed little or no differences in outcomes.

All of the studies found intensive treatment to be associated with an increased risk of hypoglycaemia (low blood sugar). The authors summarise the findings of these three studies thus: Taken together, the three trials show that no reduction of clinically meaningful adverse outcomes occurred in patients with long standing type 2 diabetes treated to a glycated haemoglobin below 7.0% in the time periods studied. Moreover, intensive treatment is accompanied by substantial costs and an increased risk of hypoglycaemia and perhaps mortality.

The authors point out that these studies were done in older individuals (mean age 60+) with quite long-standing illness. There is some evidence that more intensive therapy in younger individuals (mean age 54) with newly diagnosed diabetes [5]. Nevertheless, the authors argue, the current state of the evidence gives us enough reason to reconsider the conventional wisdom regarding blood sugar control in type 2 diabetes.

They bring up another interesting point too, when they question whether all strategies that reduce HbA1c levels have the same effect. Even for a given level of blood sugar lowering effect, different drugs or combinations of drugs may have very different effects on the outcomes that matter (like risk of disease and death). As they point out, our knowledge in this area is quite unsatisfactory.

It seems that not only is the UK government’s recent move to lower the HbA1c targets for GPs not particularly evidence-based, there is a risk it might actually do more harm than good. The authors of the BMJ piece use some good old-fashioned plain-speak to conclude their piece by stating: The change of target from 7.5% to 7% should be withdrawn before it wastes resources and possibly harms patients.

Best wishes RRB
Cheers rrb - very interesting article. Perhaps goesbsome way in helping Know why on diagnosis the health care professionals are keen to 'agrresivly' 'attack' with drugs on diagnosis?

Be good to find some more recent info too. Might be a good time to chuck in an info request to our local MP's whilst they are still pawing for our votes as we sure as hell won't hear from the after may!
 
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phoenix

Expert
Messages
5,671
Type of diabetes
Type 1
Treatment type
Pump
GP funding in the UK is horribly complicated but from what I gather an individual person with diabetes doesn't come with a pot of money.
Funding is for the practice and has to cover everything from salaries to loo rolls. It comes under several headings including a global sum which depends on number/age/gender of patients, where the practice is etc. There are also other payments for what they call enhanced services Wiki gives a summary http://en.wikipedia.org/wiki/General_medical_services
On top of this there is the QOF Framework which is the incentive scheme that RRBs article describes . This targets change a bit every year . The practice is given targets for each indicator and if they get the a high enough percentage of patients past that threshold then they get so many points. The percentage of patients that each practice has to get through the various targets also depends upon the type of practice ( so an inner city practice with a socially deprived or very mobile population might have a lower threshold than a practice in an area where the patients are more likely to attend appointments.

The value per QOF point for 2014/15: is

  • £156.92 for England
  • £154.83 for Wales
  • £133.47 for Scotland
  • £145.35 for Northern Ireland

This year the overall QOF scheme has been reduced considerably http://nbhottopics.blogspot.co.uk/2013/11/a-new-beginning-201415-gp-contract-for.html
I've attached the QOF indicators for England, you can find those for the other countries here http://bma.org.uk/practical-support-at-work/contracts/gp-contracts-and-funding/independent-contractors/qof-guidance/qof-guidance-7th-revision
qof 1.png

qof2.png
 
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Sid Bonkers

Well-Known Member
Messages
3,976
Type of diabetes
Type 2
Treatment type
Diet only
Dislikes
Customer helplines that use recorded menus that promise to put me through to the right person but never do - and being ill. Oh, and did I mention customer helplines :)
On top of this there is the QOF Framework which is the incentive scheme that RRBs article describes .

As reported in Pulse magazine 23 December 2014
Pulse Magazine said:
The QOF seems set to be a casualty of the commissioning revolution cutting a swathe through primary care.

NHS England has given the green light for CCGs across England to ditch the framework as they please and replace it with the agreement of local practices, without having to seek explicit permission.

And a Pulse investigation has revealed that CCGs have the hunger to do just that.

At least 12 CCGs are already discussing plans to replace the QOF with local incentive schemes, with one CCG aiming to implement it as soon as April.

The plans vary, but Pulse has learned that GPs in some areas could be given the option, if they wish, of funding for longer appointments for certain conditions and working with secondary and community providers towards shared outcomes, instead of following the QOF.

The GPC is understandably concerned about potentially losing one of the most prominent pillars of the national GP contract. But this concern is not necessarily shared by grassroots GPs, some of whom believe it will help cut bureaucracy and focus on local priorities.

http://www.pulsetoday.co.uk/your-pr...issioning-drive/20008812.article#.VRkkGuGrH-I

Link may not work as you need to be registered to view most content, although aimed at HCP's although you do not have to be a GP to register.
 

Scardoc

Well-Known Member
Messages
494
Cheers rrb - very interesting article. Perhaps goesbsome way in helping Know why on diagnosis the health care professionals are keen to 'agrresivly' 'attack' with drugs on diagnosis?

Be good to find some more recent info too. Might be a good time to chuck in an info request to our local MP's whilst they are still pawing for our votes as we sure as hell won't hear from the after may!

The QOF system is not limited to diabetes and not entirely based on treatment targets, it is also concerned with making sure that diabetics, for example, are attending their appointments, receiving the necessary check ups and being asked the relevant questions that they should be asked.

As incentives go I think it's a good one. If they can make some extra money out of me by making sure they get me in and check me over etc then on you go!
 
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