Plan for local QOFs raises postcode lottery fears

The GPC has warned that a locally determined quality framework will create a postcode lottery across the UK, after a DoH paper revealed that the idea is back on the agenda.

An NHS 'Next Stage Review' newsletter, published this month, shows the DoH and NICE plan to allow 'a greater local choice of indicators' in the quality framework.

The indicators will be sensitive to local health needs and priorities and could be selected from a 'national menu'.

A DoH spokesman told GP: 'A list of indicators of clinical quality which are available or could easily be developed will be online shortly for a consultative survey, to help us obtain expert feedback from frontline staff.'

The U-turn comes after Mark Britnell, the director general of the NHS, said that there was no suggestion there would be 152 different quality frameworks across the country (GP, 9 May).

GPC deputy chairman Dr Richard Vautrey said: 'The current indicators are evidence based and apply to all patients no matter where they live.'

A local quality framework would create a postcode lottery and lead to fragmentation in care, he said. 'Having a national framework enables you to measure standards of care across the country,' he added.

But NHS Alliance chairman Dr Michael Dixon said a choice of targets would help balance local and national priorities.

'The menu could cover indicators aimed at tackling teenage pregnancies and obesity and even physical activity,' he said.

Dr Colin Waine, chairman of the National Obesity Forum, backed local targets for obesity. 'We know the areas with a high prevalence of obesity,' he said.

Timeline: Local QOF

  • December 2007: National Primary Care Research and Development Centre calls for local variations in framework indicators.
  • April 2008: Professor David Colin-Thome, national clinical director of primary care, tells MPs the quality framework would address local issues.
  • May 2008: Mark Britnell, NHS director general, tells GP that a local quality framework is not on the agenda.
  • Sept 2008: DoH and NICE discuss local indicators.

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