From April 2019, 28 ‘low value’ indicators worth 175 points in total will be retired, including annual cholesterol check for diabetes, dementia bloods, annual FEV1, osteoporosis and peripheral artery disease indicators.
Some 101 points will be recycled into 15 'more clinically appropriate indicators, some of which are modifications of existing indicators', the GPC said. The remaining 74 points will cover a new quality improvement domain, made up of two modules each worth 37 points. The overall number of points available will remain the same.
Blood pressure control targets will change so that they align with NICE guidance. Meanwhile new indicators will cover reducing iatrogenic harm and improving outcomes in diabetes care; supporting age-appropriate cervical screening; offering pulmonary rehabilitation (where available) for patients with COPD' and a focus on weight management for patients with schizophrenia, bipolar affective disorder and other psychoses.
Earlier this year NICE recommended that eight new indicators for diabetes should be added to the QOF that aim to support more personalised care. The indicators use stratification based around whether or not a patient has moderate or severe frailty to set treatment targets and reduce cardiovascular risk.
For 2019/20 the quality improvement modules will cover prescribing safety and end-of-life care. The prescribing module will cover the safe prescribing of NSAIDs, lithium and valproate in women of child bearing age. Meanwhile the current QOF indicator on end-of-life care has been retired, and the quality improvement module will focus on the wider aspects of care for patients who are expected to die within the coming months as well as support for their carers.
The GPC and NHS England are working with the RCGP, NICE and the Health Foundation to develop the modules.
There will also be changes to exception reporting, which will be replaced with 'a more precise "personalised care adjustment",' the GPC said. Practices will be able to select one of five different reasons for adjusting care and removing a patient from the indicator, including:
- The QOF-prescribed care being unsuitable for the patient
- Patient choosing not to receive the prescribed care
- Patient not responding to invitations
- Where the specific service is not available (in relation to a limited number of indicators only)
- Newly-diagnosed or newly registered patients, as per existing rules.
There will be no threshold increases in 2019/20.
NHS England and the GPC have also agreed an ongoing programme of review of the QOF. Changes are planned in 2020/21 for heart failure, asthma and COPD indicators and mental health changes will be introduced in 2021/22.
The changes to the QOF form part of a five-year deal, which GPC chair Dr Richard Vautrey said was the most significant change to the GP contract in 15 years. The contract will deliver increased funding for primary care networks to enable them to expand the primary care workforce by over 20,000 people over the next five years. A deal on indemnity will also cover GPs and practice staff for clinical negligence liabilities.
A survey by GPonline last year found that almost half of GPs believed the QOF should be scrapped.