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Cutting QOF indicators may harm quality, NICE admits

By Lilian Anekwe

NICE may be forced to reinstate indicators it removes from the QOF if quality is found to slip as a result, a leading official at the institute has conceded.

The admission came as a leading primary care academic warned quality could decline in some areas, but that this was the price to be paid for introducing new indicators.

Val Moore, implementation director at NICE, told the institute's annual conference quality would have to be closely monitored after removal of indicators. She admitted it was possible ‘the information will come back to bite us'.

NICE has been handed responsibility for reshaping the QOF and plans to retire existing indicators that are deemed to have become part of established clinical practice, to make room for the introduction of 10 new indicators a year.

But Professor Helen Lester, senior clinical lecturer at the National Primary Care Research and Development Centre, told delegates quality might slip in some areas. ‘We need evidence for if and when indicators should be removed and put back in.

‘There may be occasions where care of patients with, say, asthma might slip, but then the lighthouse will swing on other groups of patients.'

She said preliminary research suggested incentives ceased to drive quality after a few years in the contract, which might justify their removal.

Dr David Colin-Thome, the Department of Health's primary care tsar, suggested proposals for a local QOF could be used to prop up care in areas that decline after being removed from the national framework.

He told delegates at the first national QOF consultation event in London: ‘We will have a process for making sure non-incentivised work is still being done. One way might be to incentivise work locally.'

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