Scrapped QOF indicator increased LARC uptake, study finds

A QOF indicator for contraceptive counselling that was scrapped in the 2014/15 contract deal had helped an extra 110,000 women access long-acting reversible contraception (LARCs), a study has found.

Nexplanon: LARC use increased under QOF indicators now retired (photo: SPL)
Nexplanon: LARC use increased under QOF indicators now retired (photo: SPL)

A study by Imperial College London suggested that prescribing rates of LARC methods had increased by 4% annually following the 2009 introduction of the QOF contraception incentive.

The indicator, known as CON002 in the 2013/14 contract, said GPs should discuss LARC alternatives with female patients when they were prescribed contraceptive patches or pills, but this has now been scrapped following negotiations between NHS England and the GPC.

CON003, which rewards GPs for discussing LARCs with women seeking emergency contraception, is still part of the 2014/15 contract, however.

LARCs, including intrauterine devices, injections and hormonal implants, have much lower failure rates than contraceptive pills or condoms, but rates of use had been historically low compared with other forms of contraception.

Researchers showed these QOF indicators were associated with a 6% annual increase in injectables, the most commonly prescribed LARC method, over the past five years and a 20% increase in implant prescribing.

The authors suggested that this equated to an overall 110,000 extra women being prescribed with LARCs since they were introduced.

As part of its September 2013 review on QOF, NICE recommended that the CON002 indicator, among others, should be retired. It said there was a general consensus that its high achievement rates suggested it was ‘now part of good practice’ and it ‘did not require incentivising’.

GP previously reported how practices have struggled to provide patients with LARCs, despite their benefits and efficacy. There are fears that scrapping the QOF indicator could undo years of GPs’ hard work to increase the uptake of LARCs, which have previously experienced other setbacks, including being subjected to misleading negative media coverage.

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