How has the GP management of depression changed since 2006? Exploring the effects of the QOF, the economic recession and NICE guidelines on rates of diagnosis, antidepressant prescribing and referrals

We aim to look at GPs’ care of people with depression from 2003 to 2012, using the information which is available through a database called the Clinical Practice Research Datalink (CPRD), gathered together from hundreds of general practices’ computerised records of their patients’ treatment. The number of GP prescriptions for antidepressants has increased greatly in recent years, from 34million per year in 2007-2008 to 50 million in 2011-2012, and we want to understand why this is happening. It may be that more people are being diagnosed with depression, perhaps because of unemployment and financial problems following the economic recession since 2008. It may also be due to GPs prescribing longer courses of treatment, so that each person diagnosed receives more prescriptions on average over time, as recommended by the National Institute for Health and Care Excellence (NICE) which gave advice to GPs on its treatment in 2004 and again in 2009. We have to look at individual patients’ records to find out, because the national information only gives us the total number of prescriptions, and not numbers of patients. In particular we want to see whether there is evidence that GPs’ use of questionnaires to measure patients’ symptoms of depression, for which GPs were paid through the national Quality and Outcomes Framework (QOF) from 2006 onwards, made a difference to the care of patients, including the prescribing of antidepressants but also referrals for psychological (talking) therapies and psychiatric treatment. The results will help us understand how the treatment of depression is changing in response to these issues, and how future NICE guidelines and changes to the QOF might encourage general practices to develop their assessment and treatment of depression in ways which can improve outcomes for patients.