National basis needed for local QoF variants

Local variations in the quality framework should be based on work that has been piloted nationally, according to a report from the National Primary Care Research and Development Centre (NPCRDC).

It argues that if PCTs are given the opportunity to use some local quality framework variants that recognise differences in local populations and health needs, any indicators they use should be drawn from a piloted national set.

The GPC and NHS Employers are in negotiation about how the quality framework could change in April 2008.

The NPCRDC report makes a number of recommendations about possible change. These include the removal of some indicators or conditions, although it says 'it is not clear what rules should govern removal from the quality framework'.

The report also suggests that indicators could be removed on a rotating basis, for example, conditions could rotate on a three- to four-year cycle.

It adds: 'We do not know what the impact of taking indicators out of the quality framework would be on quality of care.'

The report says piloting is essential when indicators are introduced into the framework.

It recommends that the overall proportion of general practice income dependent on the quality framework should not increase. It adds that there is anecdotal evidence of a disproportionate effect of the quality framework on professional behaviour. 'It may be that the proportion of overall practice income dependent on the quality framework should reduce in future,' says then report.

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