Exclusive: Czar pledges to limit local QOF variation

DoH consults on changes to quality targets as GPs warn local flexibility could cause postcode lottery.

The vast majority of quality framework indicators will remain UK-wide despite plans for local flexibility, according to the DoH national clinical director for primary care.

Speaking exclusively to GP, Dr David Colin-Thome said proposals to give PCTs greater flexibility to choose indicators would form a minor part of the revised framework.

'The local element will be quite small,' he said. Asked if a figure of around 5 per cent seemed likely, he said local indicators would make up 'a low percentage', of that order.

Proposed changes to the way quality indicators are reviewed were set out in a DoH consultation launched last week.

Under the plans, indicators will be assessed for clinical and cost effectiveness by an expert group appointed by NICE. Primary care organisations or national governments could be handed powers to select indicators from a national menu.

The BMA warned that allowing regional choices of indicators could lead to a postcode lottery in patient care.

The DoH said the quality framework is an incentive scheme, not national standards.

'We are not saying that we want different levels of achievement across PCTs. We want to provide incentives so that outcomes in all PCTs are brought up to the level of the best,' Catherine Jenkins, head of the DoH's quality team, told GP.

The consultation document also outlines plans for a faster turnover of quality indicators. Ten new indicators could be introduced each year, with those that no longer need incentivising 'retired' from the framework.

Each cycle of review is expected to take two years, including eight months to develop and pilot each indicator.

'The pilots will be looking out for unintended consequences of the indicators,' Dr Colin-Thome said. 'We need to get real, practical experience and look at how difficult it would be to introduce a particular indicator.'

Professor Helen Lester, a GP and adviser to the DoH on the quality framework, welcomed the plans. 'Reviewing and retiring indicators is a good idea, but there need to be clear rules on removal and mechanisms to track achievement afterwards,' she said.

Dr Colin-Thome said he expected academic units to bid to conduct reviews. The consultation ends on 2 February 2009.


Current indicators
The 88 current indicators to be reviewed at 20-30 a year.
New indicators
NICE will develop 10 new clinical indicators a year.
NICE will receive £600,000 to oversee the review.
GPC and NHS Employers to decide core UK targets.

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