NICE sets out bid to slash QOF workload

A raft of 'less important' QOF targets could be scrapped and timeframes to meet indicators lengthened to shrink the framework and cut the strain on GP workload, according to NICE advisors.

NICE advisors said many QOF targets could be scrapped with little impact on patient care
NICE advisors said many QOF targets could be scrapped with little impact on patient care

The proposals, set out by NICE's QOF advisory committee, are the clearest sign yet that the government wants to significantly reduce the size of the QOF in next year's GP contract.

It follows a request by NHS England for NICE to consider how to shrink the QOF to focus on indicators on with the greatest value and discard unnecessary targets.

Minutes from a meeting of the commitee, published last week, show NICE's advisors believe the government was wrong to cut the timeframes to complete indicators from 15 to 12 months.

They said the change, enforced by the DH after a breakdown in negotiations last autumn, had 'increased workload' without 'any change in the quality of care to patients'.

'The timing of the end of the annual cycle of 31 March in the first year means that practices were under most pressure to meet the indicator thresholds at the precise time when winter workload is at its peak (February and March),' they said.

There was 'much to be gained and little to be lost' by reverting to the 15-month timeframe, they advised.

The review was intended to give NHS England advice on which indicators could be scrapped 'in the event that the number of indicators in QOF were reduced', but was not a formal set of recommendations.

However, the advisors proposed that some of the targets imposed by the DH, and subsequently criticised by the GPC, could be removed with 'little impact' on patient care.

'Major workload implication'

Removal of the much-maligned targets to give the General Practice Physical Activity Questionnaire (GPPAQ) to hypertensive patients would have 'minimal impact on patients' health', the committee agreed.

In hypertension, the committee said BP checks could be taken at least annually, rather than every nine months, to reduce workload without affecting care.

Indicators to record BP in all patients over 40 and to give lifestyle advice to hypertensive patients were deemed 'less important' to retain.

However, AF indicators are a 'very important area to retain in the QOF', advisors said, warning that cutting back on these targets 'may pose a risk to patients'.

Similarly, targets for CHD, heart failure, peripheral artery disease, stroke and TIA, hyperthyroidism, asthma, COPD, dementia, should all be protected, advisors said.

Targets for tighter HbA1c control in diabetes were highlighted as a 'major workload implication', and assigning personal targets 'may be more appropriate'. But the committee said existing indicators should not be removed 'until further evidence relating to individualised target levels for patients has been evaluated and indicators piloted'.

Incentives to encourage flu vaccination in at-risk groups could be shifted out of the QOF into DESs, they said.

Committee members also asked whether the government's quality and productivity (QP) indicators could be reduced in size, but were told these are 'outside the remit of this committee'.

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