Chris Lancelot: QOF suggestions in response to consultation

NICE wants clinicians to suggest new QOF targets, but the QOF mechanism itself needs an overhaul first.

The GP Record, by Fran Orford www.francartoons.com
The GP Record, by Fran Orford www.francartoons.com

The rules are often over-complex and incomplete when the QOF year begins, sometimes self-contradictory, occasionally misaligned with clinical practice and can produce perverse incentives.

QOF was designed to reward effort and good practice. If the prevalence within an indicator is nil (for example, where a practice has no patients taking lithium) the practice loses all the QOF points under that indicator.

Unfortunately, many PCTs rank practices by their QOF score. Practices with no patients in particular indicators are therefore unable to score as highly as neighbouring practices and appear to the outsider to be less competent. Some PCTs even insist that practices receiving no complaints should not score points for their complaints mechanism, thus ranking a complaint-free practice lower than one that has received complaints galore.

The solution? Practices should receive maximum points on all indicators with zero in the denominator. (Prevalence adjustments will largely correct for the financial aspects.)

Missing a single patient in a large practice makes little difference. But in a small practice one patient may represent 33 per cent of the denominator: miss her and you can never achieve a 70 per cent score. Where the denominator is small, target thresholds should be adjusted downwards.

All QOF rules and associated Read codes should be finalised and available by the preceding 31 December.

Time-dependent targets (such as in cancer, hypertension and depression assessments) should not apply to patients registered with a different practice at the time of diagnosis. A new practice shouldn't be tarred with an old practice's failings, nor discover it has just two days from the patient's registration to complete the assessment.

Why review cancer patients within six months of diagnosis? They usually receive intensive hospital treatment and support in this period. Surely the best starting point for a GP assessment is after curative treatment has been attempted/completed?

To contribute your own ideas, go to http://tinyurl.com/QOFideas. Consultation closes on Monday.

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