Time to Choose, a report by Macmillan Cancer Support, calls for ‘urgent attention’ to be given to an overhaul of QOF end of life indicators.
‘The current indicators for end of life only require participating GPs to maintain a palliative
care register and hold three-monthly multi-disciplinary case review meetings to discuss the people on the register,’ the report says.
To reflect best practice, these indicators would need to require health professionals to assess patients’ needs and preferences, draw up an advance care plan, and record patients’ choices on an electronic palliative care register that is shared with other health and social care professionals.
‘Indicators could include the number of patients with an advance care plan and preferences recorded on an electronic palliative care register,’ the report says.
Macmillan also warns that incentives for practices through QOF, enhanced services and Commissioning for Quality and Innovation (CQUIN) payments for providers are ‘poorly aligned’.
The report says: ‘Different schemes, such as enhanced services, CQUIN payments and the QOF, were poorly aligned, often inconsistently applied and not always adequately focussed on quality.
‘NHS England should work with stakeholders to understand how the system of incentives for end of life care should be improved.’
CCG targets and the NHS Constitution should also be updated to reinforce patients’ rights, Macmillan says.
CCG outcomes indicators should require them to support patients to die where they choose.
‘The NHS Constitution should be amended to include a right for patients to express a preference about where they are cared for at the end of life, and for that preference to be recorded and shared with professionals involved in their care,’ the report adds.