I feel I must raise my head above the parapet. I was a member of the mental health group that helped develop the indicators for the depression QOF. There, I have admitted it!
Professor Toop1 has made several errors that need correcting
The first two depression indicators (DEP1 and DEP2) were introduced in 2006, after the publication of the NICE guidelines (CG23) on depression. The indicator (DEP1) was introduced because depression is more common in people with diabetes and heart disease,2 that the effect of the comorbid mental health conditions significantly effects outcomes and resource utilisation,2 and that effective treatments are available.2 Not to have incentivised GPs to identify a group of people who were more at risk clinically, using more health resources, and could be offered an effective intervention, would have been negligent.
There are three NICE guidelines (CG90, CG91, CG123) that recommend questionnaires to support the assessment of the patient, and are not used in a single reductionist approach to decision making.
Studies that showed that GPs don't like using the questionnaires also showed that patients like the use of questionnaires, they feel as though their symptoms are being taken seriously, and that they can understand their progress overtime. The use of questionnaires is seen by patients as beneficial, not intrusive.
If nurses do not feel competent to provide initial support for people who are distressed, and to raise questions that are appropriate to their care, then that is an issue for their employers to address. Nurses should be competent to ask the questions in the ultra short questionnaires, and on the basis of the patient's response provide initial advice and support.
Professor Toop also failed to mention the development called Improving Access to Psychological Therapies (IAPT).4 This is £0.7 billion development in England that recruits and trains therapists to deliver psychological care. The programme also draws on the NICE guidelines on depression and has pioneered the routine use of the PHQ-9 and the GAD-7 at every contact the patient has with the therapist.
Taken together, the development of QOF domains for depression and the development of the IAPT programme, represent a whole system approach to a condition that is debilitating, common, and costly to the NHS. It seems extraordinary that Toop seeks to undermine this approach with a poorly argued discourse on the use of questionnaires in mental health conditions.
- © British Journal of General Practice 2011
