GPC 'totally opposed' to proposed QOF target for recording BMI of all adult patients

The GPC has expressed its 'total opposition' to a QOF indicator proposed by NICE for the 2017 contract that would incentivise GPs to record the BMI of every adult patient every five years.

Dr Andrew Green: total opposition to BMI indicator (Photo: JH Lancy)
Dr Andrew Green: total opposition to BMI indicator (Photo: JH Lancy)

NICE has recommended that GPs should record the BMI of every patient over the age of 18 every five years in its QOF menu for the 2017/18 year.

The proposed indicator, one of two recommended by NICE, goes beyond current QOF targets, which currently incentivise GPs to keep a register of patients with a BMI over 25.

Subject to approval before being added to the contract, it would pay GPs based on what proportion of patients aged 18 or over have had their BMI recorded by the practice over the preceding five years, or within five years of their 18th birthday.

Dr Andrew Green, chairman of the GPC clinical and prescribing subcommittee, warned there 'was not one shred of evidence' that doing this would benefit the health of patients, and collecting the data would be 'pointless'.

NICE said the indicator draws on evidence from its Obesity identification, assessment and management guidance, last updated in 2014.

This guidance states GPs should use ‘clinical judgment to decide’ when to measure a person’s height and weight, and should make use of opportunities such as registration and health checks to do so.

Recording BMI

NICE publishes its menu of potential indicators each year once they have been evaluated and tested across pilot areas.

The other indicator recommended in the menu would incentivise treating type 1 diabetes patients with statins if they are over 40 and have had diabetes for over 10 years or if they have established nephropathy or other CVD risk factors.

A further recommendation suggests that one of the current diabetes indicators should be slightly amended to better align with the national diabetes audit (NDA).

Negotiators from NHS England and the devolved administrations of Northern Ireland and Wales will now decide whether to add the indicators to each country’s respective contract, due to be implemented in April 2017.

Scotland has already confirmed that the QOF will be absent from its breakaway contract, which will diverge from the UK GMC contract for the first time next year.

The new multispecialty community provider (MCP) contract will also drop the QOF, according to NHS England.

Obesity strategy

Dr Green said: ‘We have already expressed our total opposition to the use of BMI measurements as a quality marker, there is not one shred of evidence that the recording of this in itself will significantly affect individual patients health, and the collection of this pointless data would decrease the time available for us to provide effective healthcare.

‘This would appear to be a sop to the anti-obesity agenda designed to avoid the difficult political decisions that would need to be taken with respect to the population’s diet and the actions of multinational companies that would be required for an effective national anti-obesity strategy.’

He added: ‘It is notable that NICE has distanced itself from the QOF negotiation process and has confined itself to stating that it considers these suitable for QOF, rather than that they should be included. GPC has been involved in this change in emphasis and welcomes this important change in position.’

A total of eight indicators were initially put forward by NICE for consultation in February, with six failing to make the cut in the final menu, including one calling for GPs to conduct annual anticoagulation reviews for AF patients.

GP Dr Andrew Black, also deputy chair of the NICE indicator advisory committee, said: ‘Obesity figures in England are too high, with 61% of adults being overweight or obese.

‘The intent of this indicator is to help normalise weight measurement in general practice. BMI is a recognised measure of whether a person’s weight is suitable for their height. It can be used as a way to monitor a person’s weight over time and, alongside clinical judgement, it can help us set achievable weight loss goals for our patients. The NICE indicator incentivises routine BMI measurements for adults for this very reason.’

New indicators added to the NICE menu

  • NM142: Of the patients with type 1 diabetes who meet the following criteria: aged over 40 years and who have either had diabetes for more than 10 years, or who have established nephropathy or other CVD risk factors; the percentage currently treated with a statin.
  • NM143: The percentage of patients aged 18 or over (on or after 1 April 2017) who have had a record of a BMI being calculated in the preceding 5 years (and after their 18th birthday).

Amendments to existing indicators

  • NM14: The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 59 mmol/mol or less in the preceding 12 months. [previously read 58 mmol/mol]

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