Potential QOF indicator dropped to protect patients

A QOF indicator for palliative care has been dropped from development because pilots showed it could cause patients harm, the leader of the piloting programme has revealed.

Prof Lester: qualitative feedback from GPs had caused concern (Photograph: RCGP)

Professor Helen Lester, professor of primary care research at the University of Manchester, said piloting meant potential indicators could be axed before being passed to negotiators at the GPC and NHS Employers.

‘Of 13 indicators that we were working on piloting, 11 actually got through the advisory committee and went on to be negotiated,’ she said.

One of these, for palliative care was dropped due to the potential for patient harm. Professor Lester explained how qualitative feedback from GPs had caused concern.

‘A lot of the practices were already asking the question as part of the Gold Standards Framework,’ she said. ‘But what they said to us was that actually, as part of a whole package of questions within the GSF it worked very nicely, but you take it as an isolated QOF indicator and that can potentially cause patient harm.

‘This is a complex issue with patients who are incredibly vulnerable and are there not possible unintended consequences of making this a tick box exercise? That is what we heard very clearly.’

She said that a minority of GPs involved in the pilot had given examples of what would be considered poor practice. ‘There are currently some 53,000 people on the palliative care register, if only 10 per cent of practices missed the spirit of the indicator in the way I described then that means you’ve got 5,000 incredibly vulnerable people being asked something very, very inappropriate.’

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