NICE threshold review could drive QOF indicator targets up by 16%

Threshold changes mean GPs would have to work harder for QOF points.

Top thresholds for all QOF indicators could be raised by up to 16 per cent under plans set out by NICE.

NICE's QOF review committee has proposed that thresholds be matched to practices' current levels of achievement.

QOF thresholds

- NICE proposed linking QOF thresholds to current performance.

- Upper thresholds could match performance at the top half (50th centile) or top quarter (75th centile) of practices.

- A 50th centile cut-off would raise threshold by 12 per cent on average.

- A 75th centile cut-off would raise thresholds by 16 per cent on average.

Upper limits could be set at levels achieved by the top quarter or half of practices (the top 75th or 50th centiles) with lower limits potentially matched to the achievement of the bottom 1 or 5 per cent of practices, the review committee has said.

Wiltshire GP Dr Gavin Jamie, a QOF statistics expert, has calculated that introducing these thresholds would, on average, raise current upper thresholds by about 12-16 per cent and bottom thresholds by between 12 per cent and 53 per cent.

'The practical upshot for practices is more work to get the same money, or the same work to get less money,' Dr Jamie said. 'No indicator gets easier and many - even at the 50th centile - get much harder.'

NICE recommended that thresholds be reviewed regularly. Raising thresholds would, the review committee suggested, 'act as an incentive for improved performance'.

It pointed out that, at present, achievement rates for all but three indicators were 'substantially higher' than the maximum thresholds.

However, the committee decided to leave threshold negotiations to the GPC and NHS Employers to discuss.

GPC deputy chairman Dr Richard Vautrey said it was appropriate that final decisions were left to the negotiators. But he said the GPC expected to face pressure to raise thresholds.

'There is pressure every year to change the thresholds,' he said. 'We believe the thresholds should stay as they are.'

Previous experience had shown changing thresholds had a big impact on practices and patients and raised exception reporting rates, he added.

NICE also warned that raising thresholds might increase health inequalities.

Dr Jamie said the potential change in thresholds was 'the most significant aspect of the whole recommendations'.

'This is likely to have a far greater impact on practices than anything else,' he told GP.

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