NICE suggests axing nine indicators from 2010

QOF change 46 points up for grabs as talks start on altering diabetes, stroke and hypothyroidism pay.

Nine indicators worth 46 points face being axed from the 2010/11 QOF and replaced by new targets for diabetes, epilepsy and Down's syndrome, following recommendations by NICE.

With half of the indicators under threat of removal relating to diabetes, the GPC and Diabetes UK have warned that the changes could undermine patient care.

GPC deputy chairman Dr Richard Vautrey said that retiring these indicators would mean fewer resources were available to provide a comprehensive diabetes service for patients.

Diabetes UK warned that removing indicators could help mask variations in care and increase health inequalities.

NICE has proposed adding two new BP targets for patients with diabetes, in place of the current 145/85 target, as well as indicators for family planning in epilepsy and a thyroid-stimulating hormone test in Down's syndrome (see box).

The suggested changes will be discussed by the GPC and NHS Employers later this month, including whether the total number of points within QOF will remain the same.

NHS Employers and the GPC are unable to change the wording of the indicators proposed for inclusion and they cannot add any indicators which have not been through the NICE process. However, they can retire indicators outside of those suggested by NICE.

Negotiations will also consider whether GPs will still have to record achievement levels for retired indicators, even though points attached to this activity may have been removed.

NICE believes there is a low risk that patient care would be affected if five of the indicators proposed for retirement were removed.

These indicators, for recording BP in diabetes, heart disease and stroke patients and HbA1c and cholesterol in diabetes, are all linked to outcome indicators.

But Dr Vautrey said that the value of process indicators must not be overlooked.

'Ignoring the value of process indicators risks undermining the foundations of QOF,' he said.

Professor Helen Lester, deputy director of the National Primary Care Research and Development Centre, which is leading the review of indicators, stressed that the new system still includes process indicators.

'NICE and the advisory committee are aware of the problems of attribution in primary care and the need to include, for example, some monitoring indicators, rather than moving towards a wholly outcomes focused QOF,' she said.

Proposed Indicator changes

IN - New indicators proposed by NICE

  • Patients with diabetes with a BP of 150/90
  • Patients with diabetes with a BP of 140/80
  • Family planning advice for women with epilepsy
  • Thyroid-stimulating hormone test record for adults with Down's syndrome

OUT - Indicators proposed for retirement

  • Patients with diabetes with a BP of 145/85 (18 points)
  • Record of BP in CHD patients (CHD 5) (7 points)
  • Record of BP in stroke patients (STROKE 5) (2 points)
  • Record of BP in diabetes patients (DM 11) (3 points)
  • Record of HbA1c in diabetes patients (DM 5) (3 points)
  • Record of cholesterol in diabetes patients (DM 16) (3 points)
  • Serum creatinine or eGFR in diabetes patients (DM 22) (3 points)
  • Serum creatinine and TSH in patients on lithium therapy (MH 4) (1 point)
  • Thyroid function tests in patients with hypothyroidism (THYROID 2) (6 points).



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