Outcomes-based QOF 'very difficult' to design

DoH plans to shift the focus of the QOF from processes to patient outcomes will prove 'difficult' to achieve, a senior NICE adviser has warned.

Dr Hunter: foresees QOF trouble (Photograph: Solent News)
Dr Hunter: foresees QOF trouble (Photograph: Solent News)

Dr Colin Hunter, chairman of NICE's QOF indicator advisory committee, said the move to outcome measures was likely to represent the future of the framework.

But he warned of the difficulties involved in realising this goal. 'In principle, the focus on outcomes would appear to be the direction of travel. The difficulty is getting appropriate outcome measures that work and deliver,' he said.

Indicators must produce a definitive outcome within a year or two to be feasible, said Dr Hunter. 'It's actually very difficult to identify (these outcomes).' But he said that any difficulties in defining outcomes measures should not block development of the QOF in this direction.

Before the election, the Conservatives pledged to 'unpick' the QOF, with a greater emphasis on outcomes over process.

Plans are likely to be outlined later this year when changes to the GP contract are announced.

The current state of the QOF was criticised by delegates at the 2010 LMCs conference in June. Glasgow GP Dr Murray MacPherson described the QOF as 'bursting at the seams' with indicators and clinical domains.

GPs agreed that the QOF had become too complicated and was having a detrimental impact on consultations. Dr Hunter said that although there was some evidence for this, the QOF only made up a small percentage of a GP's overall workload.

Clinical outcomes would show whether the framework was working or not, he said. There was increasing evidence to suggest that QOF was delivering results, he added.

However, he said there was a need to re-evaluate the effectiveness of the framework to show it was continuing to achieve results.

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