More transparency needed for QOF changes

The devil is in the detail, they say. Of course, it helps if you are expecting that detail in the first place.

Many GPs will have been surprised by some of the contents of the BMA's latest guidance on the changes to the quality framework for 2008/9.

Everyone had been expecting a reduction in holistic and management points to fund the much debated and reviled access indicators. So changes to staff recruitment and training indicators were hardly a shock.

However, changes in some of the clinical indicators were unexpected. These included changes to the indicator for COPD diagnosis and for ACE-inhibitor use in chronic kidney disease patients.

These changes were made by the quality framework expert panel which reviews current indicators and submissions for new ones. However, up until now we have only heard of the recommendations for new indicators that were rejected by the government.

It may be that this year has been unusual and any hint of these changes has been completely overshadowed by the extended hours battle. But the result is that GPs were learning of recommended changes in practice just days before the new indicators came into force. And if any were too swamped to check the guidance immediately, they may well have continued with the old indicators.

Regardless of extended hours, the quality framework review process is somewhat occult, with the workings of the Review Panel shrouded in mystery. It may be possible to find out what submissions have been made for review but not to discover the nature of the debate that led to them being accepted or rejected.

The Review Panel completed its work in October and one assumes made its recommendations at that time. However, GPs have only been made aware of the changes this week and more information on the evidence behind the changes would have been useful.

The quality framework review could benefit from a more open approach that informed GPs on the reasons for changes. One way to do this would be to take a leaf out of NICE's book and publish draft changes in, say, September or October with details of the evidence base.

There would then be a short consultation period for interested parties to enter the debate before final recommendations were made.

This would obviously add transparency to the process, but it would also provide GPs with a heads-up over potential changes in practice, and for GPs in turn to prepare other practice staff for those changes.

QOF changes are generally about good clinical practice - it seems unnecessary and unhelpful to cloak such debates in secrecy.

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