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BP indicators in QOF are ‘too simplistic’

By Cato Pedder

Targets based on risk factors such as blood pressure are too simplistic a way of measuring the quality of GP heart disease care, warn experts.

They argue QOF payments should be based on measures such as proportion of patients on preventive treatment and how intensively they are treated.

But GP specialists said that complicating targets could be counter-productive.

Professor Bruce Guthrie, professor of primary care medicine at the University of Dundee, argued in this week's BMJ that practices can earn maximum QOF hypertension payments despite failing to intensify treatment to achieve tighter control in individual patients.

But GP cardiovascular experts said simple outcome measures were the only practical way to assess GP performance for now and risk factor points would be gradually phased out.

Overall, 15% of QOF payments, worth £200m, come from measuring cardiovascular risk factors and recording if they are below specified levels.

In an accompanying editorial, consultant cardiologist Dr David Wald of the Wolfson Institute of Preventive Medicine, London, said many of the QOF measurements relating to CVD achieved little.

Dr Wald said changes to the cardiovascular indicators, being drawn up by the QOF expert panel, should reflect a ‘much simpler strategy' for treating and preventing CVD.

‘Performance indicators should not be based on the measurement of risk factor levels but on the proportion of people with existing vascular disease or diabetes, or those above a given age, who receive effective preventive treatment,' he said.

Dr Stewart Findlay, a GP in Bishop Auckland, County Durham, and Primary Care Cardiovascular Society member, defended the current system, and warned against making the QOF too complicated.

He said: ‘If you are going to performance-manage people you have to have something you can measure easily.'

He added: ‘Rewards for just doing measurements were clearly intended to get GPs used to the system and will be phased out. There is no reason why we couldn't use the points that are then freed up to reward GPs for appropriate treatment.'

Earlier this year Pulse revealed ministers were considering merging a number of separate cardiovascular indicators in the QOF into one, to combat concerns over double counting and make space for other indicators.

Professor Martin Roland, director of the National Primary Care Research and Development Centre, said the streamlining of cardiovascular indicators could create space for more treatment-oriented indicators, but there was still a place for the measurement of risk factors in the QOF.

Dr Stewart Findlay: warned against overcomplicated QOF targets Dr Stewart Findlay: warned against overcomplicated QOF targets Argument for QOF change

Argument for QOF change

• Analysing data from his 2002 observational study of 560 hypertensive patients from eight general practices, Professor Bruce Guthrie found treatment was not intensified in 45% of consultations where patients had a single suboptimal BP reading (<140 5mmhg="" without="">
• No intensification occurred in 36% of consultations after two successive suboptimal readings.
• Yet the eight practices would have achieved near maximum points for blood pressure control if QOF had been in place, despite appreciable ‘therapeutic inertia'.

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