Exclusive: NICE 'must lower QOF targets'

GPs have called for 'impossible' QOF targets that force practices to meet ever-increasing clinical thresholds to be scrapped as part of a NICE review.

NICE is set to review how achievement thresholds for new QOF indicators are developed later this summer, GP has learned.

The DH asked for the review after introducing controversial ‘performance matching’ reforms to QOF indicators from 2013/14.

The reforms – rejected in Scotland, Wales and Northern Ireland, but introduced in England – mean GPs miss out on maximum QOF points unless they ratchet up achievement each year to match top performers from previous years.

Cost-cutting

GP leaders said far tougher thresholds in this year’s QOF in England are a ‘cost-cutting’ exercise that would damage practice income. They called for thresholds to fall and said NICE’s review must help to ensure targets are set for clinical, not financial, reasons.

NICE advises contract negotiators on appropriate thresholds for new and significantly changed indicators, using results from pilots to inform its recommendations.

The review forms part of a wider rethink of how NICE develops new targets for GPs. A public consultation will run later in the year.

NICE said that it had not yet considered whether it would seek to reverse the DH’s new performance matching system.

GPC deputy chairman Dr Richard Vautrey told GP an urgent rethink was needed on how targets are set.

‘While many thresholds have increased this year, the majority will increase next year and keep on increasing in following years, making it almost impossible for any busy GP to have any idea what target they are aiming for,’ he said.

‘This increased complexity and punitive higher targets set purely for financial rather than clinical reasons have seriously undermined QOF.’

He added: ‘In any review, NICE needs to stand up to the DH to ensure clinical evidence and validity are put before cost-cutting. Thresholds need to come down and GPs need to be confident that QOF is working to support good clinical care, not undermine it.’

North Yorkshire GP Dr Terry McCormack, secretary of the British Hypertension Society, criticised thresholds for a new BP indicator introduced this year. It requires GPs to treat hypertensive patients under 80 years old to a target of 140/90mmHg and is worth up to £7,846 to an average GP practice.

Thresholds 'critical'

GPs who piloted the BP indicator warned threshold levels would be ‘critical’ to acceptability in the wider profession.Yet upper targets were set at 80%, although the average pilot practice only increased patients treated to target from 52% to 61%. Dr McCormack said just one practice in the pilot reached 80%.

‘You can’t base evidence on an outlier,’ he said. ‘It’s about how you measure top-performing practices. You cannot assume that just because one practice produces one result, that is reproducible by everyone else.’

An NHS England spokeswoman said it expected NICE ‘to recommend new thresholds using available evidence on baseline performance and workload implications for practices’.

A spokeswoman for NICE said: ‘NICE will be undertaking a public consultation on an indicators process guide in the late summer and autumn and thresholds will be part of the process guide consultation.’

She added that NICE is not involved in contract negotiations, but provides negotiators with information from piloting that can inform QOF thresholds.

Expert view: Wiltshire GP Dr Gavin Jamie

How QOF thresholds penalise GPs in England

As thresholds rise, most practices will get less money for doing the same work, or gain the same money for more work. Thresholds are no longer consistent between practices – Scotland, Northern Ireland and Wales will all have lower thresholds than those in England.

Ever-rising thresholds will increase pressure on practices, possibly threatening the viability of the indicators. There will be more pressure too on patients to attend, and necessarily an increase in exception reporting.

Setting targets is difficult and requires great clarity about what you are trying to achieve. Setting a standard that is achievable and desirable is a delicate balance.

My personal preference is for the system in Scotland, which has remained challenging to practices, although no upper threshold is to be increased above 90%

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