QOF targets must not be outside GP control

Only health outcomes within GPs' control should be included in QOF, a NICE committee has ruled.

Professor Lester: it is crucial to ensure indicators could be attributed appropriately
Professor Lester: it is crucial to ensure indicators could be attributed appropriately

Members of the NICE QOF advisory committee had raised concerns that moving QOF towards a focus on public health outcomes could mean introducing targets over which GPs do not have control.

NICE has warned that changes in public health and economy influences may obscure how healthcare in a particular area affects outcomes.

In addition, University of Leicester research has shown that risks of death from CHD are principally related to factors such as ethnicity and deprivation, rather than local health interventions.

At a meeting in Manchester last month, the NICE QOF advisory committee voted on a statement to clarify its stance.

The committee, which approves QOF indicators before they pass to GPC and DoH negotiators, agreed that any indicators must be within the control of GPs. QOF indicators have to be attributable for payments, the committee’s chairman Dr Colin Hunter said.

GPC negotiator Dr Chaand Nagpaul welcomed the decision. ‘It is sensible, logical and fair that GPs should be judged and rewarded for performance on indicators that are fully within their control,’ he said. ‘We welcome the commitment to continue that.’

Professor Helen Lester, who leads the piloting of potential QOF indicators for the committee, said it was crucial to ensure indicators could be attributed appropriately.

‘It would be unfair to pay, or not pay, a GP for something outside his or her control,’ she said. ‘It could also exacerbate the inverse care law.’

Leicester GP Dr Steve Levene, who led the University of Leicester study, told GP that data from small groups would be needed to show whether the impact of interventions could been seen at the practice level.

‘If you want to look at what effect life interventions have, it is probably best done either at the level of small groups of patients, or at a practice-level,’ he said.

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