Practices to be measured on 'retired' QOF aims

Performance on indicators retired from the QOF must continue to be monitored, according to researchers assessing the framework for NICE.

Prof Lester: part of QOF review
Prof Lester: part of QOF review

The experts said it was vital to assess how cutting incentives affected achievement.

Achievement could be assessed using the General Practice Extraction Service or the QResearch database, a team from the National Primary Care Research and Development Centre (NPCRDC) has said.

The researchers published their analysis of indicator removal in the BMJ last week.

They set out a rationale for identifying indicators that should be removed from QOF, such as when achievement is high, or has reached a ceiling.

Payments could be gradually, rather than immediately, reduced for indicators which have been removed from the framework, the researchers suggest.

The NPCRDC, led by deputy director and part-time GP Professor Helen Lester, is reviewing QOF indicators for NICE's Independent QOF Review Committee.

GPC negotiator Dr Chaand Nagpaul said the committee recognised that there would be a need to refine the QOF and that some indicators would need to be retired on the basis of changing evidence.

But, he said it was important not to consider QOF as simply rewarding achievement.

'QOF was always designed to fund not just performance, but also workload,' he said.

'Where there is high achievement, that may reflect high workload and so we cannot assume that where GPs perform well payment can be withdrawn without affecting achievement.' He also stressed the importance of recognising the role played by process, rather than outcome-focused, indicators.

'Many indicators of greatest benefit support processes and it is legitimate to fund those,' he said.

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