'Next generation' QOF targets delayed

A new type of QOF indicator that rewards GPs for more personalised care has suffered a setback due to technical issues.

The first 'tightly linked measure' for the QOF has been delayed for another year
The first 'tightly linked measure' for the QOF has been delayed for another year

The introduction of more flexible targets, called tightly linked measures (TLMs), may now be delayed until 2015/16, four years after they were first proposed.

TLMs reward clinically meaningful treatment even if patients do not hit 'gold standard' targets.

The first TLM in development would reward GPs for lowering cholesterol in diabetes patients even if they don't reach optimal levels of less than 4mmol/l.

The target was developed as a more tailored approach to the QOF, which has been criticised for promoting 'tick-box' medicine. The diabetes indicator was first proposed in June 2011 and piloted during 2012.

NICE's QOF advisors were due to debate proposing the target for next year's GP contract during a meeting in Manchester on Wednesday.

But advisors heard how the measures have been delayed after developers encountered issues extracting essential prescribing data from GP systems.

The team behind the measures reported they had run into difficulties extracting information on dosing of statins, which is vital to determine whether GPs have met the terms of the complex new target.

QOF advisors will receive an update on progress to rectify the issue in the committee's December meeting.

It means the indicator is likely to be delayed until the 2015/16 contract at the earliest.

Speaking to GP in January, Rachel Foskett-Tharby, QOF developer and researcher from Birmingham University, said the new measure would 'bridge the gap' between process and outcome-based indicators.

'I think it does recognise that not all patients will reach the outcome [target] and that isn't necessarily due to practices not taking appropriate steps to get them there,' she said.

The proposed indicator:
1. The percentage of patients with type 2 diabetes aged 40 years and over with successful lipid management defined as either:

a. Last recorded cholesterol in the preceding 12 months ≤4.0mmol/l.
b. Last recorded cholesterol in the preceding 12 months >4.0mmol/l and commenced on a moderate dose generic statin within 90 days of cholesterol recording.
c. Last recorded cholesterol in the preceding 12 months >4.0mmol/l and generic statin dose increased within 90 days of cholesterol recording.
d. Or, last recorded cholesterol in the preceding 12 months >4.0mmol/l and cholesterol lowering therapy changed to a different drug within 90 days of cholesterol recording.

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