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Exclusive: NICE to review QOF on costs

By Lilian Anekwe

QOF indicators that are not delivering value for money are set to be scrapped as part of a sweeping review by NICE of the current framework.

Sir Michael Rawlins, chair of NICE, told Pulse in an exclusive interview that the institute had been asked to assess the cost-effectiveness of QOF indicators.

NICE will also be responsible for recommending future indicators for inclusion – but only if they are cost-effective as well as clinically beneficial.

Lord Darzi's NHS Next Stage Review handed NICE a central role in setting the agenda for future versions of the QOF, including refocusing it on public health and shifting the emphasis from process to outcomes.

Sir Michael told Pulse that from April 2009 NICE would work with the QOF expert panel to bring the audit targets in the GP contract in line with the clinical targets in the institute's guidance.

He said: ‘We want to make sure there aren't any contradictions between NICE guidance and the QOF. If we say something is cost-effective or isn't cost-effective it would be better if the same thing was reflected in the QOF.'

He made clear that the same standards would apply for both new and existing indicators: ‘It's likely to be both that we review what is currently in the QOF for cost-effectiveness, and that we assess what we include in the future on the basis of its cost-effectiveness.

‘In the future the things that are included in the QOF will be there having been assessed on the basis of the cost, as well as their clinical effectiveness,' he said.

Once possible clinical indicators have been drawn up by NICE, they will then be discussed by the QOF expert panel and GPC negotiators.

The Government has already signalled its intent to streamline the QOF and ensure it is more cost-efficient.

Smoking indicators were unified into a single domain in the 2006/7 QOF review, and Pulse has revealed officials were examining ways to do the same with cardiovascular indicators to prevent what ministers regard as ‘double counting'.

Dr Richard Vautrey, deputy chair of the GPC, said: ‘Part of the current process takes cost-effectiveness into consideration. While it's not explicit, I would be surprised if there were many indicators that were not cost-effective.'

He added: ‘Where there are differences there are good reasons for it. I don't see there's a need for each set of guidance to be exactly identical.'

NHS Employers said: ‘We will continue to lead on negotiations with the GPC, but going forward NICE will lead on the evidence-gathering process to inform any changes.'

How NICE and QOF conflict

Lipid modification - NICE advises GPs aim for a target of 4mmol/l for total cholesterol, whereas the QOF rewards GPs for hitting a total cholesterol of 5mmol/l or less in patients with established CVD.
Blood glucose - NICE guidance says GPs should aim for an HbA1c level of 6.5% in all patients. But QOF indicators measure the percentage of patients achieving an HbA1c of 7.5% or more.
Blood pressure - Blood pressure targets for hypertension are 140/90mmHg in NICE
guidance but 150/90mmHg in the QOF. BP targets also differ for diabetes and CKD.

Sir Michael Rawlins: wants to stamp out contradictions between NICE guidance and the QOF Sir Michael Rawlins: wants to stamp out contradictions between NICE guidance and the QOF

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