NICE reveals suggestions for QOF changes

NICE has released its menu of indicators for the 2011/12 Quality and Outcomes Framework (QOF), covering BP, dementia, diabetes and mental illness.

The 10 new indicators will be considered by NHS Employers and GPC negotiators this winter and those accepted will be added to next year’s QOF.

The proposed changes focus largely on processes, which could slow progress towards the outcomes-based QOF the DoH is keen to pursue.

Under the new indicators, GPs would have a wider range of treatment choices for MI patients. Other indicators promote checks for patients with dementia and mental illness, and foot tests for diabetes patients.

QOF proposals
  • Expanded BP drug choice for MI patients
  • Health checks for new dementia diagnoses
  • Foot sensation tests for diabetes patients
  • Risk classification for feet of diabetes patients
  • Six indicators covering checks for patients with mental illness

GPC deputy chairman Dr Richard Vautrey said he would expect 2011/12 QOF negotiations to be influenced by the DoH’s desire to move towards outcomes-based indicators.

In a White Paper consultation document, the DoH said QOF was ‘failing to deliver any significant degree of continuous quality improvement’.

‘We want the QOF to focus more on the health outcomes that are achieved for patients and to provide incentives for continuous improvements,’ it said.

Dr Vautrey said: ‘A pure focus on outcomes alone may undermine the health inequalities gains QOF has made in recent years, as the evidence clearly demonstrates the benefit of investing in process measures, which will ultimately achieve the best long term outcome for all patients.’

Indicators selected by NHS Employers and the GPC will be added to the changes to the 2010/11 QOF agreed as part of the swine flu pay deal last year.

NICE also recommended four indicators for retirement. These include: cholesterol checks for patients with CHD (CHD7); recording seizure frequency (EP6) and medication review (EP7) for epileptic patients; and following up on patients with mental illness who do not attend their annual review (MH7).

These will join seven other indicators earmarked for retirement last July. Indicator MH7, for patients with mental illness on lithium within the theraputic range, will not now be retired in light of new evidence.

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