Seven QOF indicators backed by NICE for next GP contract

The NICE Indicator Advisory Committee recommended seven new QOF indicators on Monday, which negotiators will consider for inclusion in the 2016/17 GP contract.

GP consultation: Potential QOF targets revealed (Photo: JH Lancy)
GP consultation: Potential QOF targets revealed (Photo: JH Lancy)

A total of 12 indicators were up for discussion at the meeting. Of these, six were approved, with one further indicator devised during the meeting added to the 'QOF menu' for NHS England and the GPC to consider. Three were bundled together or included with other trial indicators and a further three were rejected.

Seven indicators added to NICE menu

IND1 – Severe mental illness: The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses aged 25-84 years (excluding those with pre-existing CHD, diabetes, stroke and/or TIA) who have had a CVD risk assessment performed in the preceding 12 months. Recommended threshold: 45-80%.

IND2 – Obesity: The percentage of patients with coronary heart disease, stroke or TIA, diabetes, hypertension, peripheral arterial disease, heart failure, COPD, asthma and/or rheumatoid arthritis who have had a BMI recorded in the preceding 12 months. Recommended threshold:  40-90%.

IND3 – Immunisations: The percentage of patients with coronary heart disease, stroke or transient ischemic attack, diabetes and/or chronic obstructive pulmonary disease who had a flu vaccination between the preceding 1 August and 31 March. Recommended threshold: 55-95%.

IND6 (bundled with IND7) – Depression and anxiety: The percentage of patients with a new diagnosis of depression or anxiety in the preceding QOF year whose notes record an offer of referral for psychological treatment within 3 months of the diagnosis. Recommended threshold: 45-80%.

IND9 (includes IND8) – Primary prevention of CVD: Percentage of patients aged 25-84, with a new diagnosis of hypertension or diabetes who have had a face-to-face cardiovascular risk assessment using the QRISK2 risk assessment tool within 3 months of the date of the diagnosis. Recommended threshold: 40-80%.

IND11 – Primary prevention of CVD: Percentage of patients aged 25-84, with a new diagnosis of hypertension or diabetes who have a recorded cardiovascular risk assessment score of 10% or greater who are given lifestyle advice. Recommended threshold: 40-90%.

IND11a (includes IND10) – Primary prevention of CVD: Percentage of patients aged 25-84, with a new diagnosis of hypertension or diabetes who have a recorded cardiovascular risk assessment score of 10% or greater who are currently treated with statins. Recommended threshold: 40-80%.

Proposed QOF indicators rejected

Three of the indicators were not added to the menu, but the committee decided that IND12 should be piloted and discussed again at the next meeting. IND4 will be revised before going through further pilots.

IND4 – Vulnerable patients: The practice can produce a register of patients who are either resident in a care home or who are housebound.

IND5 – Vulnerable patients: The percentage of patients recorded as being resident in a care home or housebound who have had a medication review recorded in the preceding 12 months.

IND12 – Primary prevention of CVD risk: The contractor establishes and maintains a register of patients with a 10-year risk of CVD of 10% or more. 

Alterations to current indicators

The committee recommended changes to the following severe mental illness indicators, which are still part of the QOF in Scotland and Wales, but not in England. It recommended lowering the minimum age limit from 40 to 18, and timeframe from 15 months to 12 months.

NM18  The percentage of patients aged 18 and over with schizophrenia, bipolar affective disorder and other psychoses who have a record of total cholesterol:HDL ratio in the preceding 12 months.

NM42  The percentage of patients aged 18 and over with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood glucose or HbA1c in the preceding 12 months.

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