New type of QOF target unveiled by NICE

A novel kind of QOF indicator that allows GPs to earn points by meeting different criteria for different patients has been formally proposed by NICE.

The target, for lipid control among patients with type 2 diabetes, is the first 'tightly linked measure' (TLM) to be proposed. It comes after months of development and piloting.

Birmingham GP Professor Helen Lester, who leads the team that developed the indicator, told GP last month that it should mean GPs are not penalised for failing to hit targets among patients in whom good clinical control is harder to achieve.

Instead, they would be rewarded for good clinical practice regardless of their starting point.

However, the proposed measure would also require GPs to aim for a more aggressive target cholesterol level than the current QOF indicator.

It follows criticism from GP leaders and the wider profession that the QOF has promoted a 'tick box' culture that overlooks the needs of individual patients.

Now, NICE has formally included a TLM for the first time in its proposals for 2013/14 framework, one of 20 new indicators to be proposed.

If approved, the indicator would pay GPs to manage lipids among patients with type 2 diabetes aged 40 years and over. GPs need only to meet one of four criteria in order to earn points in this indicator.

Currently, GPs are awarded points for the percentage of patients achieving 5mmol/L or less.

Under the new measure, GPs would earn points for the percentage of patients with a recorded cholesterol in the past 12 months of 4.0mmol/L or less.

But if a subset of patients cannot reach this target, GPs would still earn points if these patients were prescribed a moderate dose generic statin within 90 days of the cholesterol recording.

If such patients were already taking a statin, a GP would need to increase the dose within 90 days of a recording. Similarly, a GP could instead switch a patient onto a different statin to achieve points in this indicator.

It means that for patients with very high cholesterol in who the 4mmol/L target is unachievable, GPs can still earn points for good clinical practice.

The targets are based on NICE Guideline 66, the management of type 2 diabetes, and the new NICE Quality Standard for diabetes.

If approved following consultation, the new indicator would likely replace existing measure DM17, which awards six points for patients with a recorded total cholesterol of 5mmol/L or less.

In its rationale for the new indicator, NICE wrote: 'This potential new QOF indicator aims to test out the feasibility of implementing and extracting data on a tightly linked measure for diabetes lipid management for UK QOF.'

TLMs may also reduce the risks of overtreatment, the institute said.

NICE will consult on all 20 of the new indicators until 6 February.

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