RCGP fears NICE advice may skew QOF outcomes

Outcomes for patients with comorbidities could be skewed if quality indicators are based on NICE guidelines for single conditions, according to a recent statement from the RCGP.

The college raised the concerns in response to the DoH consultation on reforming the review process for QOF indicators.

The response points out that much of the evidence base for NICE guidelines is developed through assessment of treatments for single diseases in hospitals.

'Often these guidelines do not take account of patients with multiple conditions,' the RCGP said. Inappropriately aligning these guidelines with the QOF would risk skewing outcomes in primary care, the college believes.

'Primary care deals with patients with multiple conditions and GPs must take a holistic view on clinical care,' the response added.

'For example, patients should not always be prescribed all the medicines that would otherwise be appropriate to the single diseases when suffering from multiple conditions.'

This must be taken into account in the way that the QOF is updated and implemented, it said.

The RCGP also joins the chorus of calls rejecting plans for local quality indicators.

'QOF is a national framework and as such is unable to fully adapt to local health economy needs,' it argued in the response.

'We believe that local priorities should be funded through the existing mechanism of local enhanced services.'

Local enhanced services can, if properly managed, address specific local health needs or requirements, the response added.


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