GPs face 'outcomes targets overload', patient group warns

The NHS risks being swamped by too many outcomes targets and should revert to one register of good health outcomes, according to a patient group.

Dr Leng: 'NICE is actively looking at its processes to improve efficiency'
Dr Leng: 'NICE is actively looking at its processes to improve efficiency'

Speaking at the NICE annual conference in Birmingham on Wednesday, Laura Weir of the independent patient group Patients Involved in NICE (PIN) said the range of outcomes frameworks being published by the DH may damage attempts to provide integrated care.

Ms Weir said:  'I believe outcomes are becoming more, not less, important in improving delivery of care across health and social care divide. Yet our national policy agenda does little to encourage this.

'We have an NHS outcomes framework, a public health outcomes framework, a social care outcomes framework, a commissioning outcomes framework (COF), a QOF, and we're soon to get a long-term conditions outcomes framework. We have outcomes overload.

'One might question whether such a plethora of frameworks is compatible with integrated care.'

She questioned whether instead of multiple frameworks, the NHS should instead build 'a register of actual health outcomes by condition, backed by some universal descriptors of quality of care, with financial incentives to achieve the health outcomes that really matter?'

She added: 'There's a real opportunity for NICE to lead the way on producing integrated guidance.'

Ms Weir also questioned whether NICE would inadvertently increase variation in quality of care by focusing only on areas with a 'convenient' evidence base for its quality standards.

She said: 'If there is no quality standard, there will be no COF indicators either. To respond [only] to where there is an evidence base only risks reinforcing the variation that already exists.

'If NICE's central ethos is about reducing variation, it needs to be responding to need when developing guidance, rather than simply where there is a convenient evidence base, otherwise NICE becomes a barrier to improving patient outcomes.'

NICE announced at the conference that it has increased the number of quality standards it plans to produce by 30, taking the total to 180. It will publish a full programme in April 2013.

Quality standards are set to inform future indicators for the QOF and the new COF that will be used to judge GP commissioners' performance. Yet, at present, just 21% of quality standards are published or in development.

Dr Gillian Leng, NICE deputy chief executive, told the conference that the institute was 'actively looking at its processes to improve efficiency' of producing quality standards, suggesting it will attempt to produce them faster.

In response to PIN, Dr Leng, added on integration: ‘Integrating guidance across health, social care and public health is a core feature of future NICE quality standard development. Some of this will be informed by integrated guidance, such as our dementia guideline, but in other cases it will be done by looking at a range of guidelines. We will need to identify important areas for integration as we start to scope the new library. In addition, we are also integrating guidance in the NICE Pathways, where we will bring together related guidance from a range of different areas.’

On use of evidence, she said: ‘We have always had a process for referring topics to NICE where there is a need, but no evidence - we then use the best evidence there is, together with expert consensus.  Examples include our neonatal care quality standard and our clinical guideline on referral for suspected cancer.’

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