Retiring QOF indicators may undermine care, NICE told

NICE will need to agree lower thresholds for indicators retired from the QOF to stop standards of care falling, the group reviewing indicators says.

Dr Lester: 'People need to agree up front what is an unacceptable level of decline - a trigger point to consider reintroduction' (Photograph: NTI)
Dr Lester: 'People need to agree up front what is an unacceptable level of decline - a trigger point to consider reintroduction' (Photograph: NTI)

If performance falls below a 'trigger point', a retired indicator should be reviewed for reintroduction into the QOF, the National Primary Care Research and Development Centre says.

The proposal comes as research shows removing financial incentives from indicators can affect performance levels.

The centre's deputy director, Professor Helen Lester, who led the study, said action should be taken if achievement on retired indicators fell. 'People need to agree up front what is an unacceptable level of decline - a trigger point to consider reintroduction,' she said.

In an ideal world, Professor Lester said, an equilibrium would be reached where the minimum financial incentive is provided to maintain performance at an acceptable level.

'But primary care is a busy environment. If you take money away it's understandable that GPs and primary care teams switch from spending time on one area to another,' she said.

Dr Lester and her team studied the effect of removing financial incentives from screening for diabetic retinopathy and for cervical cancer in a US centre.

In the five years when financial incentives were attached to screening for diabetic retinopathy, screening rates rose from 85 per cent to 88 per cent. In the following four years, after the incentives were removed, this rate fell to 81 per cent.

A similar picture was seen for cervical screening rates, which rose with incentives, but fell once incentives were removed.

The results suggest policy makers may need to consider step-wise reduction of payments for indicators rather than blanket removal, the researchers said.

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