QOF to incentivise annual anticoagulation reviews for AF patients

GPs could be paid for yearly reviews of anticoagulation therapy in AF patients under QOF targets proposed by NICE for 2017/18 as part of a drive to reduce strokes.

The latest proposed indicator set published by NICE aims to tighten up the identification and management of AF, thought to contribute to one in five strokes.

It also calls for GPs to be paid through QOF to measure the BMI of all patients over 18 every five years, with another proposed indicator recommending that GPs should give overweight patients weight mangement advice within three months of measuring their BMI.

Patients are 'not receiving appropriate advice and management' to reduce their risk of stroke, NICE experts warned.

GPs should be paid based on the proportion of AF patients who have had their anticoagulation reviewed with the last 12 months to ensure they are receiving appropriate treatment, a proposed indicator says.

Evidence from NHS Improvement suggests that 8,000 strokes could be prevented annually, which could save the NHS in the order of £95m a year.

Stroke prevention

A raft of QOF, CCG and other GP indicators have been drawn up for potential inclusion in the 2017/18 contract.

Other QOF indicators up for consultation include one on maintaining a register of patients with chronic kidney disease and another on treating diabetes patients over 40 with statins.

NICE has also proposed other general practice indicators which are ‘not suitable for inclusion in national incentive schemes at this time’, but which could be considered for use in local or national quality improvement initiatives.

These include giving older patients and patients with comorbidities pulse palpation and carrying out HbA1c checks on women with a history of gestational diabetes.

A consultation on the proposed indicators will run for four weeks until 29 February, after which a confirmed list of indicators will be rolled out to pilot areas. The finalised menu will be decided by the NICE indicator advisory committee in June 2016.

Negotiators – including NHS Employers and the GPC – will then use the menu to help decide which indicators are included in the GP contract.

Proposed QOF indicators

Stroke is the third biggest cause of death in the UK, running up costs of £8.9bn in 2009. Some 110,000 people have a stroke each year in England.

Professor Gillian Leng, NICE deputy chief executive, said: ‘These draft indicators are intended to improve public health one patient at a time. The indicators are a key part of NICE’s drive to save and improve people’s lives, enhance the quality of care in the NHS and use its scarce resources wisely.

‘We’d like everyone with an interest in the development of evidence based indicators to tell us their views. Feedback will help us decide which indicators to put forward for publication on the NICE indicator menu.’

Dr Andrew Black, GP and deputy chair of the indicator advisory committee said: ‘These potential indicators are being developed in a way that would allow them to be used by practices and CCGs for service development and improvement, as well as for QOF.’

Draft wording of QOF indicators up for consultation:

IND QOF1: The percentage of patients with atrial fibrillation and a CHA2DS2- VASc of ≥2 at any time who are not currently treated with anticoagulant therapy who have had a review of the risks and benefits of anticoagulation in the preceding 12 months

IND QOF2: The proportion of people with atrial fibrillation who are prescribed anticoagulation who have a review of the need for and quality of anticoagulation in the preceding 12 months

IND QOF3: The contractor establishes and maintains a register of patients aged 18 or over with CKD

IND QOF4: The percentage of patients with diabetes in whom the last IFCC-HbA1c is 53 mmol/mol or less in the preceding 12 months

IND QOF5: The percentage of patients with diabetes in whom the last IFCC-HbA1c is 58 mmol/mol or less in the preceding 12 months

IND QOF6: Of the patients with type 1 diabetes who meet the following criteria: aged over 40 years and who have either had diabetes for more than 10 years, or who have established nephropathy or other CVD risk factors; the percentage currently treated with a statin

IND QOF7: The percentage of patients aged 18 or over who have had a record of a BMI being calculated in the preceding 5 years

IND QOF8: The percentage of patients aged 18 years and above with a BMI ≥25 in the preceding 12 months who have been given appropriate weight management advice within 90 days of their BMI being recorded

Photo: iStock

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