The General Practitioners Committee (GPC) has questioned the move to create a composite indicator for diabetes believing it may have an adverse affect on patient care.

Measures to conduct nine separate checks in each diabetes patient will demotivate doctors, lead to increased referral rates and infringe on rights to refuse treatment, the GPC warns.

Dr Laurence Buckman, GPC chair, said in a letter to NHS Medical Director Sir Bruce Keogh that a single indicator may lead to “unintended consequences”.

The Department of Health recently asked NICE to consider a composite indicator for inclusion in the Quality Outcomes Framework (QOF) after an investigation found only half of patients received the nine existing separate checks.

But the GPC argues that if the new indicator were to be introduced it would “have consequences”, especially where patients did not wish to engage in specific checks or attend altogether.

“A composite indicator that defunded practices of the whole quantum of diabetic QOF funding – designed to fund the process, not just the outcomes – risks demotivating practices completely and would almost certainly have the unintended consequence of increasing diabetic referrals,” said Dr Buckman.

He added that a “regimented tick-box check” would be “extremely counterproductive”.

But Sir Bruce responded by defending the switch. “The QOF is currently not incentivising practices to increase the number of their patients who receive all nine care processes that are the hallmark of good diabetic care delivered to patients,” he said. “If one or two are missed, patients are not getting the care they should receive.”

A single diabetes indicator will be created for the Quality Outcomes Framework (QOF) by the DH after an investigation found only half of patients received the nine existing separate checks.

Findings from the National Diabetes Audit for 2010/11 suggest that suspected diabetes patients are not being thoroughly checked for the condition by GPs.

Sir Bruce Keogh (pictured), NHS Medical Director, has written to NICE asking it to replace the current QOF indicators with a “composite indicator measuring the proportion of patients who received all nine of the processes”.

In the letter, Sir Bruce also called for the Institute to review the range of “target measurements and associated payment thresholds”.

“We hope to work together (with NICE) and with the BMA and other stakeholders to improve the QOF and support ongoing improvements in quality and outcomes for patients,” said a DH spokesperson.

The new indicator – which would be worth more than £5,000 – could be included in the 2015 framework.

The General Practitioners Committee (GPC) filed a complaint over the data used in the audit. The DH has now launched an investigation into the complaint with the outcome expected in September.