Editorial: Any changes to the QOF must be for the better

When it was introduced, the QOF aimed to reward practices for taking a systematic approach to providing high quality care.

Six years on, the general consensus is that it has been a positive development. In 2008, a DoH report said the framework had been instrumental in improving diabetes outcomes. Meanwhile, a study by the National Primary Care Research and Development Centre, also published in 2008, showed the QOF was helping to reduce inequalities between affluent and poorer areas.

Over the years the QOF has evolved and, now that NICE has taken charge of recommending what should be included, it looks set to change further. Indicators deemed common practice will be 'retired' and new ones added each year. The government also wants to include more outcome-focused indicators.

Are these changes for the better? In this week's GP Dr Colin Hunter, chairman of NICE's QOF indicator advisory committee, says it will be difficult to define appropriate outcome measures, which makes one suspect they could be difficult to achieve.

At the LMCs conference last month, delegates warned the QOF was 'bursting at the seams'. Plans to retire and replace indicators will no doubt make this worse.

They also warned that as the QOF becomes more complicated it is having an adverse affect on patient consultations as GPs and nurses struggle to cram ever more into the 10-minute consultation.

The more frequently indicators change the greater the chance of this happening.

Of course, the framework needs to evolve if it is to reflect best practice, but policymakers must take care not to stray from the QOF's initial objective - to reward practices for providing high quality care.

Changes to the QOF are not a way to drive down costs by making indicators harder for GPs to achieve. Nor should results be used as a stick with which to beat practices.

The QOF has had a hugely positive impact on patient care. Any changes in the future must build on these achievements, not undermine them.

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