GPs face stricter BP targets in QOF menu for 2014/15

NICE has recommended 10 new indicators for next year's QOF, including targets for dementia diagnosis, tighter BP control and family planning advice.

GPs face stricter BP targets under proposed QOF targets from NICE
GPs face stricter BP targets under proposed QOF targets from NICE

NICE's 'menu' of indicators will pass to the GPC and NHS Employers, who will negotiate later this year over which targets should enter next year's GMS contract.

As expected, NICE has proposed stricter BP targets for patients with CHD, stroke or TIA, or peripheral arterial disease.

If adopted, these new goals would see GPs treat patients aged 79 or under to a target of 140/90mmHg or less. This is lower than the current 150/90mmHg goal and in line with existing targets for hypertensive patients.

The menu includes a target to use ambulatory BP monitoring to confirm a diagnosis of hypertension, despite concerns that buying enough devices may prove expensive for practices. Home BP monitoring has also been added as an option following discussions among NICE's QOF advisory committee.

Another new target would expect GPs to ensure patients with dementia have been referred to a memory service up to 12 months before their diagnosis. However, a GP investigation recently found huge waiting times at memory services across England.

A proposed indicator would require GPs to keep details of a named carer on the records of patients with dementia.

There is also a new target for advice about pregnancy, conception and contraception for patients with diabetes.

NICE also proposed changes to three existing indicators, including to tailor family planning advice for people with epilepsy and to lengthen the time allowed for tests for patients with dementia. Advisors also called for the age limit on the register for patients with learning disabilities to be removed.

Aberdeen GP Dr Colin Hunter, chair of the QOF advisory committee, said: 'The independent QOF committee has thoroughly deliberated on all of the evidence, consultation responses and feedback from piloting, so we believe that the 10 proposed indicators that we’ve put forward on today’s menu will improve the care that GPs provide for their patients.'

Professor Gillian Leng, deputy chief executive of NICE, said: 'These proposed new indicators for family doctors will help set high standards of care and improved results for patients.

'All of the proposed new indicators are based on the best evidence and have been developed in consultation with professional groups, patients and community and voluntary organisations.'

New indicators

  • The percentage of patients with a new diagnosis of hypertension (diagnosed on or after 1 April 2014) which has been confirmed by ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) in the three months before entering on to the register.
  • The percentage of patients aged 79 or under with peripheral arterial disease in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less.
  • The percentage of patients aged 79 or under with coronary heart disease in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less.
  • The percentage of patients aged 79 or under with stroke or TIA in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less.
  • The percentage of women with diabetes aged 17 or over and who have not attained the age of 45 who have a record of being given information and advice about pregnancy or conception or contraception tailored to their pregnancy and contraceptive intentions recorded in the preceding 12 months.
  • The percentage of patients with dementia with the contact details of a named carer on their record.
  • The percentage of patients with dementia (diagnosed on or after 1 April 2014) who have a record of attendance at a memory assessment service up to 12 months before entering on to the register.

Amended indicators

  • The percentage of women with epilepsy aged 18 or over and who have not attained the age of 45 who are taking antiepileptic drugs who have a record of being given information and advice about pregnancy or conception or contraception tailored to their pregnancy and contraceptive intentions recorded in the preceding 12 months.
  • The percentage of patients with dementia (diagnosed on or after 1 April 2014) with a record of FBC, calcium, glucose, renal and liver function, thyroid function tests, serum vitamin B12 and folate levels recorded up to 12 months before entering on to the register
  • The contractor establishes and maintains a register of patients with learning disabilities

Click here for NICE's summary of recommendations

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