The eight new diabetes indicators (see below) along with a new atrial fibrillation (AF) indicator, which says that people with resolved AF should remain on the AF register, have been added to NICE’s QOF menu.
The QOF menu is used as part of GP contract negotiations, where the GPC and NHS England make a final decision about what should be included in the QOF.
The new diabetes indicators use stratification based around whether or not a patient has moderate or severe frailty to set treatment targets and reduce cardiovascular risk. NICE said that the new approach would improve outcomes and decrease the risk of harm from overtreatment and had been proposed as a result of the recent review of the QOF in England.
The QOF review recognised that developing indicators that are applied across a whole population of patients with a particular condition could ‘inadvertently result in both the over-treatment of patients with severe needs, and the under-treatment of less complex patients’.
As part of the review NHS England facilitated a group of stakeholders, which included the BMA, NICE, patient representatives and the national clinical director, to investigate the feasibility of developing stratified indicators for diabetes.
NICE has consulted on draft versions of the indicators over the summer and, as a result, further indicators have been added to support cardiovascular risk assessments and statin treatment for people with type 2 diabetes.
Professor Gillian Leng,deputy chief executive and director of health and social care at NICE, said: ‘A number of the new NICE indicators for people with diabetes take account of frailty and are a step towards helping enable the greater personalisation of care. The intent of these indicators is to reduce the risk of treatment-related harm and improve the quality of life for people with moderate or severe frailty.’
The proposed change to the AF patient register follows a study published in the BMJ earlier this year, which found that strokes were almost as common in patients whose records said their AF had been resolved as among patients with current AF. The researchers called for patients to continue to receive anticoagulant medication even after they were removed from AF registers.
NICE’s proposed new indicators
- NM157 The percentage of patients with diabetes without moderate or severe frailty, on the register, in whom the last IFCC-HbA1c is 58 mmol/mol or less in the preceding 12 months.
- NM158 The percentage of patients with diabetes with moderate or severe frailty, on the register, in whom the last IFCC-HbA1c is 75 mmol/mol or less in the preceding 12 months.
- NM159 The percentage of patients with diabetes without moderate or severe frailty, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less.
- NM142 The percentage of patients with type 1 diabetes who are aged over 40 years currently treated with a statin.
- NM160 The percentage of patients aged 25–84 years, with a diagnosis of type 2 diabetes, without moderate or severe frailty, not currently treated with a statin, who have had a consultation for a cardiovascular risk assessment using a risk assessment tool agreed with the NHS Commissioning Board in the last 3 years.
- NM161 The percentage of patients with a diagnosis of type 2 diabetes and a recorded CVD risk assessment score of ≥10% (without moderate or severe frailty), who are currently treated with a statin (unless there is a contraindication or statin therapy is declined).
- NM162 The percentage of patients with diabetes aged 40 years and over, with no history of CVD and without moderate or severe frailty, who are currently treated with a statin (excluding patients with type 2 diabetes and a CVD risk score of <10% recorded in the preceding 3 years).
- NM163 The percentage of patients with diabetes and a history of CVD (excluding haemorrhagic stroke) who are currently treated with a statin.
- NM164 The contractor establishes and maintains a register of patients with atrial fibrillation, including patients with ‘AF resolved’.
The full list of NICE's proposed QOF indicators can be found here.