NICE to develop multimorbidity QOF indicators for frail elderly

NICE will develop a QOF indicator for managing patients with multiple long-term conditions, with plans to target frail elderly patients who are housebound.

Elderly care: NICE believes holistic QOF indicators are needed (photo: Paul Starr)
Elderly care: NICE believes holistic QOF indicators are needed (photo: Paul Starr)

The indicator may assign a GP to care for all aspects of a patient's health needs, including home visits. The provisional plans appear to echo parts of the 'named GP' responsibility for the over 75s introduced in April.

The proposal, which will be developed over the coming months, came from an independent QOF advisory committee hosted by NICE, which approved the plans on Thursday. Once developed, the indicator will likely undergo piloting by a group of GP practices before being reassessed.

Committee chairman Dr Colin Hunter said frail, elderly and housebound patients could particularly benefit from indicators that encouraged more holistic care.

Specific wording for the indicators was not proposed during the meeting, but Dr Hunter said GPs needed to take responsibility for these patients’ care and ensure the same GP made each home visit.

It marks the first time NICE has considered a single incentive for managing multiple long-term conditions, and aims to improve care for the growing number of patients with complex healthcare requirements.

Indicators to improve mental health care

At the meeting, the committee also decided to develop indicators to improve parity of esteem between physical and mental health patients, specifically targeting the high mortality rates of people with serious mental health problems compared with the rest of the population.

One GP advisor said it was important that all GPs were aware of the scale of the problem around high death rates in these patients.

Dr Hunter said it was vital indicators were developed well to avoid this important issue being ignored. He said the committee would also look at how enhanced services could be improved to treat patients with mental illness.

Meanwhile, the committee agreed to amend existing obesity indicator OB001, which rewards practices for registering patients with a BMI over 30, to only be applicable to patients aged over 18 instead of 16.

This was agreed in light of previous discussions, when the committee said it would explore the possibility of adding separate incentivised targets aimed specifically at overweight and obese children.

'Difficult' to introduce outcomes focussed indicators

The committee decided, however, not to impose a lower age limit on indicators to record smoking status in patients with chronic conditions. Members of the committee said such discussions warn young at-risk patients not to pick up the habit.

The committee also discussed how potential QOF indicators could be made to be more ‘outcomes focused’, as requested by NHS England.

But the members decided this would be difficult, as many outcomes only emerge in the long term, and so could not be supported by QOF. Measuring outcomes at a practice level would also be subject to huge statistical variation from practice to practice, they warned.

Dr Hunter said QOF advisors would work on the issue and report back at the next committee meeting, scheduled for December.

The committee also expressed doubts on the potential effectiveness of indicators on integrated care, as although it was clearly a 'very important’ area, it would ‘not fit well’ into the QOF, it said.

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