The National Institute for Health and Clinical Excellence’s recommendation that financial incentives for GPs to support patients with depression should be axed has sparked concern from the mental health sector.

NICE this week announced its recommendations for the quality and outcomes framework for 2012-13. The final indicators will be decided by NHS Employers and the British Medical Association’s GPs committee this winter.

It recommended that 17 QOF indicators were “retired”, including all three relating to depression. Currently GPs are financially rewarded for assessing and reassessing people diagnosed with depression and assessing diabetic patients for depression.

NICE chief executive Sir Andrew Dillon explained the decision to negotiators in a letter saying the removal was recommended by an independent QOF advisory panel.

He said: “They considered the indicators were not shown to be effective in improving processes of care or health outcomes for people with depression.”

He noted GPs had “concerns that the indicators have unintended consequences on the care provided… by encouraging what they describe as a more bureaucratic approach to identifying depression, at the expense of more engaged screening”.

Sir Andrew admitted the removal “may reduce the quality of care”. He said a “rapid review of the evidence to develop high quality, evidence based indicators” was underway to propose new indicators for the next round of negotiations in 2012.

The NHS Confederation’s Mental Health Network director Steve Shrubb said: “We are extremely concerned about proposals that, if enacted, would remove any financial incentives to identify the most common form of mental illness in GP surgeries.

“Experience also suggests that it will be very hard to get indicators on depression back into the outcomes framework once removed.  We believe the indicators should be left in place until suitable alternatives are available.” 

Centre for Mental Health chief executive Sean Duggan 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.”

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