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Independents' Day

Exercise QOF indicators are workable, says NICE development lead

Exclusive New QOF indicators incentivising practices to promote more active lifestyles are proving ‘very positive’ in pilots, claims the NICE’s development lead.

Professor Helen Lester, NICE’s clinical QOF indicator development lead, told Pulse that practices piloting the exercise indicators in patients with hypertension have embraced the challenge and come up with some innovative ideas for making it work.

The claim comes after the GPC said several of the QOF indicators incentivising practices to promote better lifestyle choices that Government wants to impose on practices were ‘unworkable’.

The indicators for 2013/14 include assessing exercise levels annually in patients with high blood pressure, and delivering a brief intervention in those who are considered ‘less than active’.

It also comes after NICE released draft guidance that said GPs should screen all adults for their exercise habits and offer advice to those not sufficiently active and its advisors agreed to pilot new QOF indicators for alcohol screening.

Professor Helen Lester, who is also a GP in Birmingham, said the results of pilots of the exercise indicators were positive.

She said: ‘The reports from the pilot practices that engaged with the indicators were generally very positive. It is a new way of working, certainly, but just because it is a new way of working doesn’t mean that it is a bad way of working.’

She said practices were coming up with ideas, such as having an exercise facilitator come in for one session a week, having a guided walk around their local area, and that they were helping patients understand just how many steps they had to do and how hard they had to work in terms of getting their heart rates up.

She added: ‘Primary prevention is definitely part of our role so I think you are on very thin ice to argue that it is not our role to prevent people from becoming ill. It absolutely is, otherwise we should now immediately stop suggestion people should not smoke.’

Professor Mike Kirby, a GP in Radlett, Hertfordshire, and professor of medicine at the University of Hertfordshire, said he supported the idea as it could have a similar effect to presciring lipid-lowering ht

He said: ‘I have always been a believer in that prevention is better than cure. With the QOF, if you incentivise practices to do things they are often very well placed to do it. Exercise can be as effective as a statin drug in preventing heart attacks and strokes.’

But Dr Richard Vautrey, GPC deputy chair, said that the introduction of the indicators went too far.

He said: ‘I think we need to be careful not to simply expect GPs to solve society’s problems by putting more and more public health measures into QOF. There are many other ways to tackle public health issues, not necessarily expecting practices to do that.

‘For instance one of the best ways to tackle alcohol issues is to raise unit pricing rather than asking practices to do more and more surveys and questionnaires.’


Readers' comments (7)

  • Anything is "workable" by the GPs - we are quite a flexible innovative bunch.

    The question as rightly pointed out by Dr Vautrey is, should public health be our job and will the cost of performing this justify it's cost?

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  • Whoever heard of Nice turkeys voting for Christmas? Please quote some evidence when you repeat deliberately selective soundbites.

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  • I think we should all install a webcam at the entry to our health centres and a reverse conveyer belt like at Heathrow terminal 5. All patients should have to enter the health centre by said conveyer belt. The speed and inclination of said conveyor belt could be adjusted according to BMI and exercise habits. This is public health in action.

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  • Primary prevention of smoking would be best achieved by banning tobacco. We prescribe exercise to patients but how many actually comply. There is a world of difference in the exercise involved in taking a statin and doing 30 minutes 5 times a week. Just as prescribing a stain has a cost so does prescribing exercise. GP time is a cost and the government clearly do not want to fund additional GP time. I am not sure what planet some of these professors live on. I think all professors should be obliged to declare how many patients they see per week. They recommend 30 minute appointments without demonstrating how to fit 30 half hour appointments into a 10 hour day - do the math. Exercise habits begin in childhood and much public health education could be done in our schools. Did Boris not recommend 2 hours PE per day! GPs have a finite time. Most patients come to a consultation with at least one clinical issue more often two. Having dealt with their clinical issues there is often no time remaining to assess exercise patterns. Just as compliance with medications is an issue so will compliance with exercise and advice to lose weight. It is about time NICE started costing their recommendations for General Practice. It is my experience that resources are often provided for pilots to make them work. The government should offer free use of exercise facilities such as swimming pools and gyms. Perhaps one of these esteemed academics can quote the numbers need to treat for this intervention. I have recently revised my approach to prescribing of statins for primary prevention based on NNT. I await the information with interest.

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  • Peter Swinyard

    I am sure pilots need exercise - they sit down all day at work. Whether they will accept this and walk up and down the cabin all day I am not sure - or have I rather missed the point???

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  • Our NICE guidelines commitee should learn from Denmark, Sweden and a Eastern Europe where exercise begins from.

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  • I see from the BMJ that if patients go on to win an Olympic medal they stand a chance of living 2.8 years longer. I'm not quite sure this is the message we need to put across, particularly from a government which has cut exercise in schools, but then politics is all about mixed messages...

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