NICE recommends two new indicators for inclusion in the QOF

NICE has recommended two new indicators – one for AF and one for people with severe mental illness – that could be included in the QOF from April 2023.

Photo: (sturti/Getty Images)

The indicators will be added to NICE's 'menu' of QOF indicators, which NHS England and the BMA use during contract negotiations to decide what should be included in the final framework for 2023/24.

NICE has recommended that people with AF and an increased risk of stroke should receive anticoagulants. This is an update of an existing QOF indicator and NICE said it was aimed at promoting the use of direct-acting oral anticoagulants (DOACs) over vitamin K antagonists, unless DOACs are declined by the patient or are not indicated.

The second indicator would introduce annual physical health checks for people with severe mental illness.

Severe mental illness

'People with severe mental illness are at a greater risk of poor physical health and die on average 15 to 20 years earlier than the general population,' NICE said. It added that if introduced the checks would 'help GPS identify and address modifiable risk factors linked to premature death'.

Earlier this year NICE recommended a range of new cardiovascular disease indicators relating to BP management and lipid lowering that could also be added to the QOF next year.

Meanwhile, at last week's England LMCs conference, GP leaders also backed an overhaul of the QOF targets for childhood immunisations. They instructed the BMA to negotiate a lower threshold for payment and the introduction of exception reporting in contract talks with NHS England, warning that current targets discriminated against practices with high patient turnover and in areas of high deprivation.

Move away from QOF

2023/24 is the last year of the current five-year GP contract in England. While the QOF will remain in place until March 2024, it is current BMA policy to push for a move away from targets to incentivising continuity of care in any negotiations about what happens from 2024 onwards.

The RCGP also backs this approach. New RCGP chair Professor Kamila Hawthorne recently told GPonline that it may now be time to scrap the QOF, something her predecessor Professor Martin Marshall has previously called for.

A report by the college earlier this year called for changes to the way general practice looks after the most vulnerable patients, moving from QOF to 'a system that encourages GPs to focus on those who need care most and cuts out the red tape and box ticking'. The RCGP also backs incentivising continuity of care.

Meanwhile a report from the influential House of Commons health and social care committee on the future of general practice last month suggested that QOF and PCN targets should be scrapped and the associated payments, worth a combined £1bn, moved into core funding.

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