Pilots give QOF standards a boost

Experts say the benefits of piloting possible QOF indicators far outweighs the costs. Tom Moberly reports.

Professor Lester: 'If just one poor indicator worth just one point is stopped from going into the framework, that shows the value of the piloting system' (Photograph: RCGP)
Professor Lester: 'If just one poor indicator worth just one point is stopped from going into the framework, that shows the value of the piloting system' (Photograph: RCGP)

Piloting potential QOF indicators in GP practices before they are rolled out across the UK has already begun to show benefits.

The first year of piloting has seen a range of indicators fine-tuned and one axed altogether as a result of initial findings, the leader of the piloting programme says.

Since October 2009, Professor Helen Lester, deputy director of the National Primary Care Research and Development Centre (NPCRDC), has led the programme piloting proposed QOF indicators.

Six-month pilots on 16 indicators have just been completed. A further group were piloted in the previous six months. Although details have not yet been released, Professor Lester says one potential indicator was thrown out based on the trials.

'With that indicator there were unintended consequences that couldn't have been anticipated,' she says. 'We found that the way the wording was followed simply did not reflect the spirit of the indicator.'


A range of other indicators needed fine-tuning, she adds, though most came through the process relatively unchanged.

The difficulty of ensuring indicators achieve their intended outcomes was highlighted earlier this year by Dr Colin Hunter, chairman of NICE's QOF Indicator Advisory Committee. He said plans for a more outcomes-focused QOF would be tough to implement.

The piloting of potential QOF indicators was introduced as part of a set of changes designed to make the QOF indicator review process more accountable.

Under the previous QOF assessment system, potential indicators were not systematically tested before being introduced, although Professor Lester says that the NPCRDC repeatedly suggested that piloting should be introduced.

She says the transparency of the new process means people can understand the basis for decisions. 'The previous process could seem like a black box to some,' she says.

'GPs just saw indicators being introduced without any information on the process or reasoning behind decisions. In the new system, it is very clear who is doing what and why.'

GPC negotiator Dr Chaand Nagpaul says it makes sense to ensure that any indicator is practical for GPs to implement. 'There is a difference between the theory of an indicator and how it is implemented in a practical sense,' he says.

'The value of piloting an indicator is to ensure that it can be implemented in the day-to-day practice of a GP.'

RCGP chairman Professor Steve Field believes that as QOF develops, researching how GPs implement indicators will be increasingly relevant. 'As we develop outcomes measures and QOF focuses more on outcomes, piloting indicators with grassroots GPs is important.'

Dr Nicholas Steel, clinical senior lecturer in primary care at the University of East Anglia, says that piloting of QOF indicators is a good thing for GPs, patients and taxpayers.

'It offers an opportunity to test whether indicators are implementable and workable in practice, and helps get the best indicators into QOF to improve quality of care,' he says.

Potential indicators are now tested in a set of 30 practices over six months. The findings are given to NICE's primary care QOF advisory committee.

The committee assesses the findings before passing recommendations to the GPC and NHS Employers who decide which indicators will be included in QOF. As the pilots have progressed, the way the assessments are carried out has evolved, Professor Lester says.

Changes to the process have tended to focus on technical aspects, such as IT issues and improving data extraction systems, but timelines for the pilots have also been adjusted.

The centre aims to pilot each of the indicators for six months, but this normally ends up being between four and five-and-a-half months.

Piloting of QOF indicators is 'money incredibly well spent from a financial point of view, let alone from the perspective of patient care and GP workload', says Professor Lester.

'Every QOF point is worth £1 million and running the QOF pilots costs just £150,000, she says.

'So, even if just one poor indicator worth just one point is stopped from going into the framework, that shows the value of the piloting system.'

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