Published: 27/05/2004, Volume II4, No. 5907 Page 3

The government is to introduce a national target for the effective case management by primary care trusts of 'highly complex patients' with chronic diseases.

Department of Health director of primary care and policy lead for chronic disease Gary Belfield told delegates at an HSJ conference on chronic-disease management that the DoH was drawing up a framework for measuring case management among patients with the most highly complex comorbidity.

HSJ has also been told by other senior primary care sources that a target on measuring the effectiveness of chronic-disease management among PCTs is being created by the DoH.

Mr Belfield told the conference that the DoH 'wanted people to really focus on case management' at PCT-level, and indicated that a target will be set in conjunction with the development of the government's public service agreements, which will be announced in July.

A document produced earlier this year by the DoH strategy unit, outlining its plans for the next five years, showed that 5 per cent of inpatients account for 42 per cent of overall inpatient days (news, page 5, 22 April).

HSJ understands that the efficiency of case management of chronic disease could also be measured by hospital admission levels.However, the government is keen to allow primary care trusts to draw up their own local priorities.

National clinical director for primary care Dr David Colin-Thomé told HSJ that whatever target was introduced it was important that it 'made clinical sense'.

'We need to find a reasonable target that is acceptable to the service, ' he said.

NHS Alliance chair Dr Michael Dixon said he believed a target for the case management of patients with complex chronic diseases was 'the right direction in which to be moving and the right area to be setting targets'.

He claimed that the 80 per cent of patients with chronic diseases who were self-managing their care would also be well covered in the quality and outcomes framework of the new GP general medical services contract.

But he warned that it was important not to ignore those patients 'in the middle, who need disease-management provision', including patients with diabetes or mental health problems.

Dr Dixon added that he would like to see PCTs assessed on whether they had effective action plans in place to case manage chronic disease placed alongside appropriate targets for reducing hospital admissions.

DoH officials have already discussed a goal of reducing inappropriate hospital admission by 30 per cent.

This would offer a strong incentive for both primary and secondary care to improve chronic-disease management.

North Sheffield PCT chief executive Andy Buck commented that it was important that any new targets for PCTs should be 'carefully selected'.

'What is needed is sophisticated performance management of the progress we make in this area.

This would require the very careful selection of targets that reflect the positive benefits derived from improved chronic-disease management, ' he argued.

NHS Confederation policy director Nigel Edwards welcomed the possibility of such targets, but warned that PCTs 'need to be able to develop local priorities.'

He said that public service agreements targets needed 'to be sufficiently wide to allow this'.