NICE bid to remove depression from QOF sparks diagnosis fears

Removing depression from the QOF is 'reckless' and will harm early diagnosis, the NHS Confederation warned after NICE claimed there was little evidence the indicators improved care.

NICE advised that all three depression indicators should be dropped from the QOF in recommendations handed to negotiators on Monday.

Its review of existing indicators, for case finding and assessment of severity, found limited evidence for their success treating depression.

The Mental Health Network, part of the NHS Confederation, criticised the decision. Director Steve Shrubb, said: ‘We are extremely concerned about proposals that, if enacted, would remove any financial incentives to identify the most common form of mental illness in GP surgeries.

He added that NHS mental health services are ‘extremely worried’ about how the state of the economy will impact on demand for services.

Mr Shrubb said: ‘Imperfect as the indicators are, our members think it would be reckless to remove the depression indicators from the GP treatment framework until suitable alternatives are in place.’

‘Experience also suggests that it will be very hard to get indicators on depression back into the outcomes framework once removed.  We believe the indicators should be left in place until suitable alternatives are available.’

NICE’s independent QOF advisory committee presented the review at its June meeting.

It found ‘low quality evidence’ to support the assessment of severity of depression, a follow-up assessment and the use of such assessments to evaluate treatment.

There was also little evidence to suggest the tools employed to measure severity agreed on changes in the patient’s condition over time, it found.

In March, research from Manchester University suggested QOF indicators for depression over-simplify case-finding in patients with long-term conditions and may adversely affect quality of care.

The findings, collated from interviews with clinicians and patients, suggest the QOF may have led to a ‘more bureaucratic and less engaged approach’ to identifying depression.

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