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QOF to be reviewed to boost cardiovascular outcomes

NICE is set to carry out a review of the cardiovascular indicators in the QOF as part of a Department of Health drive to improve mortality rates and ensure patients are ‘optimally managed’ in primary care.

The Government’s CVD strategy - published today - also pledges to expand the NHS Health Check programme to ensure better uptake by patients and ensure that GPs identify at-risk patients routinely by publishing league tables of expected versus actual prevalence rates.

Health secretary Jeremy Hunt said the strategy could save 30,000 lives by 2020, and would help tackle the ‘shocking underperformance’ of the NHS in tackling preventable disease.

The strategy says: ‘People who have been diagnosed with or at risk of a CVD are not always optimally managed in primary care.’

‘For example, people who have atrial fibrillation are not always appropriately anti-coagulated, those with diabetes do not always receive the nine key processes of care, and people with hypertension often do not have this adequately managed - so this increases their risk of CVD.’

‘People with or at risk of CVD are not always adequately supported to improve their lifestyles. More needs to be done to improve their management, in order to improve mortality rates, quality of life, patient experience and patient safety.’

‘The NHS Commissioning Board will work with stakeholders to identify how to incentivise and support primary care consistently to provide good management of people with or at risk of CVD.

‘This will include DH asking NICE to review the relevant QOF indicators and promotion of primary care liaison with local authorities, the third sector and PHE to ensure optimal provision of prevention services, including secondary prevention.’

Key points in the strategy for GPs

  • Develop and evaluate service models to manage CVD ‘as a family of diseases’
  • Improve ‘patchy’ uptake of NHS Health Checks and evaluate its impact
  • Improve case-finding in primary care and ‘provide support’ to GP practices that have low detection rates for CVD
  • Review QOF indicators for CVD
  • Publish comparisons of expected prevalence at GP practice level with reported prevalence of CV-related diseases
  • Improve the processes for identifying inherited cardiac conditions e.g. familial hypercholesterolaemia

Source: DH CVD outcomes strategy

Health Secretary Jeremy Hunt said: ‘Despite real progress in cutting deaths we remain a poor relative to our global cousins on many measures of health, something I want to change.

‘For too long we have been lagging behind and I want the reformed health system to take up this challenge and turn this shocking underperformance around.

‘Today’s proposals for those with cardiovascular diseases will bring better care, longer and healthier lives and better patient experience – which we must all strive to deliver.’

GPC deputy chair Dr Richard Vautrey commented: ‘QOF has had a significant impact on the health regulation and particularly our relationship to cardiovascular disease. There are already going to be much more challenging targets in the coming year, with quite a number of cardiovascular disease indicators, and the we would be concerned if they intentions were to make the targets even harder in the future.’

‘There may be some merit in trying to rationalise some of the indicators because there has been increasing tendencies to try to micromanage consultations. I think what we would want to see in the future is much more flexibility for clinicians to act as professionals and meet the agenda of patients rather than the agenda of someone sitting elsewhere.’

Readers' comments (3)

  • I can look forwards to prescribing more statins to fatties, boozers and smokers all in the name of QoF targets.

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  • Does other countries who score better than UK have QoF (or similar)? I suspect not.

    In which case, thing to do isn't to do more of the same but to look for a more effctive methods. It's not rocket science Jeremy, just common sense!

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  • This is another step in the right direction but what is being ignored by the report is the new technology that is readily available that can make significant impacts on patient management of early CVD in Primary Care and specifically in the targeted age group 40-74 years. The technology can provide measures that are more strongly related to the risk of cardiovascular events than just brachial blood pressure. The technology can quantify the arterial and cardiac response to a medication, intervention or lifestyle change even when there is no significant change in brachial blood pressure. This information can be used to measure response and titrate medication dosage. The technology can indicate the onset of circulatory shock, early vascular ageing and preeclampsia and can also assist in widespread screening for atrial fibrillation. What is surprising is that the current indicators used by NICE are out-of-date and need to be updated if an improvement in outcomes from CVD is the objective. It needs to include new risk measures based on measuring central (aortic) blood pressure, pulse wave velocity, augmentation index, and rhythm strip. All of these new measures have been researched to the nth degree and proven and as the technology is widely available yet seemingly ignored by NICE, including such technology in the DoH strategy would definitely drive to improve mortality rates and ensure patients are ‘optimally managed’ in Primary Care. All of the above cardiovascular measures can be obtained from a standard blood pressure cuff!

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