NICE has proposed 16 new indicators for inclusion in the 2013/14 Quality and Outcomes Framework (QOF) and rheumatoid arthritis (RA) as a new clinical area.

The recommendations include four for RA, two for men with diabetes, plus indicators for COPD rehabilitation and hypertension.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said the potential indicators “can make a real difference” to improve standards of care.

QOF is a voluntary incentive scheme that rewards GPs for implementing systematic improvements in care for patients. It operates through a points system which rewards doctors for their performance against the indicators.

Indicators for RA include GP practices creating a register of patients aged over 16, and patients being assessed for cardiovascular risk and fracture risk.

In men with diabetes, indicators focus on offering advice on erectile dysfunction and on available treatment options.

The final ‘menu’ of indicators will be decided by NHS Employers and the British Medical Association later this year.

The majority of doctors want at least a month’s notice before being inspected by the Care Quality Commission (CQC), a new survey has found.

A poll by the Family Doctor Association of 100 GP practices across England revealed that 67% would require more than 30 days’ notice, 12% called for two months’ notice, 9% wanted three months’ and 12% need between three and six months.

A spokeswoman said the Association “demands” that a minimum of a month is given for routine inspections by the CQC.

The CQC has the right to visit GP practices without notice but has said the majority of practices usually get one or two days’ notice.

Practices now have to register with the Commission before April next year. The CQC will inspect practices at least once every two years.

But the Family Doctor Association explained that GP practices are unlike other facilities the CQC inspects. “The CQC forgets that general practice is not like the hospital or nursing home sectors that they regulate,” said the spokeswomen.

“What happens if they demand to inspect a single handed practice and the doctor has just left for a holiday? What effect will it have on patients who have pre-booked a doctor appointment if at very short notice the CQC demands that the registered manager, usually a GP, is available for them?”

The CQC said it was considering its notice period as part of its inspection pilot. “Most other services registered with CQC receive no notice period when we carry out an inspection,” a spokesperson said. “To ensure our inspections do not impact on patient care during inspections a variety of notice periods are being tested, from no notice up to a 10 day notice period.”

The recently declared bankruptcy of South London Healthcare NHS Trust has been linked to Barclays Bank’s manipulation of the interbank lending rate (Libor).

Health finance experts have called for a public investigation into the impact of the Libor fraud on hospital PFI debts.

Writing in the British Medical Journal, Allyson M. Pollock and David Price said the conflict between the trust’s falling income and its escalating PFI debts was partly due to the dependence of PFI repayment rates on financial derivatives.

Barclays Capital has been convicted of fraudulently inflating the value of derivatives in order to distort the cost of bank borrowing.

Derivatives play a key role in PFI projects: investment banks such as Barclays Capital use them to secure loans against a hospital’s future revenues.

The PFI scheme for the Princess Royal University Hospital PFI in Bromley, a major factor in the South London Healthcare NHS Trust debt, relied on interest rate ‘swaps’ that created an artificially high interest rate for the deal.

Profits from derivatives are tied to Libor, and so manipulating Libor enabled Barclays Capital to defraud the trust by indirect means, the authors claim.

They argue that “a major public inquiry” is needed “to determine the full extent to which the high interest rates, swap mechanisms and swap margins fuelling the latest round of hospital and service closures are products of Libor manipulation and fraud.”

Circle claims it has both improved services and cut costs, six months into its ten-year contract to run Hinchingbrooke Hospital in Cambridgeshire.

The private health company has pointed to improved performance in the NHS hospital’s A&E and colorectal departments, as well as £1.1m cost savings.

It attributes these successes to its ‘partnership’ strategy of appointing NHS clinicians to key leadership roles.

When Circle took over Hinchingbrooke it agreed to take on the hospital’s £40m debt and, in return, to take the first £2m profit, 25% of the next £4m and 33% of the next £4m.

In six months, the company said, Hinchingbrooke’s A&E department has become the highest-performing full service trust in the region and has topped a patient recommendation poll.

In addition, “major failings’ in colorectal services have been addressed, and the speed and quality rating of its incident investigation system have improved.

The company hopes to make the hospital profitable within two years.

Ali Parsa, Circle’s Chief Executive, said: “Through Circle’s entrepreneurial drive, operating model of transferring power to the staff closest to patients and methodology of deploying leading experts from our partnership to coach staff on this journey, we have already seen big improvements across the hospital.”

The company “would love” to extend the same management model to other hospitals across the UK, he asserted.

“It’s right that Hinchingbrooke celebrates these very, very early successes,” commented Karen Jennings, Assistant General Secretary of Unison.

However, she noted “early signs of concern” over the way that Circle had cut staffing levels by outsourcing the hospital’s cleaning services, and the prospect of further redundancies.

The majority of doctors want at least a month’s notice before being inspected by the Care Quality Commission (CQC), a new survey has found.

A poll by the Family Doctor Association of 100 GP practices across England revealed that 67% would require more than 30 days’ notice, 12% called for two months’ notice, 9% wanted three months’ and 12% need between three and six months.

A spokeswoman said the Association “demands” that a minimum of a month is given for routine inspections by the CQC.

The CQC has the right to visit GP practices without notice but has said the majority of practices usually get one or two days’ notice.

Practices now have to register with the Commission before April next year. The CQC will inspect practices at least once every two years.

But the Family Doctor Association explained that GP practices are unlike other facilities the CQC inspects. “The CQC forgets that general practice is not like the hospital or nursing home sectors that they regulate,” said the spokeswomen.

“What happens if they demand to inspect a single handed practice and the doctor has just left for a holiday? What effect will it have on patients who have pre-booked a doctor appointment if at very short notice the CQC demands that the registered manager, usually a GP, is available for them?”

The CQC said it was considering its notice period as part of its inspection pilot. “Most other services registered with CQC receive no notice period when we carry out an inspection,” a spokesperson said. “To ensure our inspections do not impact on patient care during inspections a variety of notice periods are being tested, from no notice up to a 10 day notice period.”

Prescribing costs fell last year as measures to reduce the amount spent on medication began to have an impact, new data shows.

Figures from the Information Centre show there was a reduction in spending by a third of a per cent compared to 2010.

The Department of Health praised the efforts of doctors in reducing medicines spend but said further progress could still be made in this area.

Research found that a total of 962 million prescriptions were dispensed in community pharmacies in England last year at a cost of £8.831bn.

However, this total was down on the £8.834bn spent 12 months before.

The reduction in overall spend followed a reduction in the mean net ingredient cost of the average prescription falling from £9.53 to £9.16. Reduced drug tariff prices and smaller payments to pharmacists also contributed.