Depression must not be excluded from general practice quality framework, say mental health organisations

Embargoed until 01 August 2011

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 they provide.

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 years.

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 well-being."

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 crucial."

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 prioritised accordingly."

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.

References:

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.