GPC warning over plans to retire QOF indicators
By Lilian Anekwe
GP leaders have warned that plans to retire as many as five QOF indicators risk 'undermining' patient care.
The new NICE-appointed committee on the QOF this week named five indicators it believes could be retired from the QOF with little or no impact on patient care.
The QOF advisory committee considered a list of indicators for retirement proposed by academics at the National Primary Care Research and Development Centre at a meeting in July, and drew up list of indicators for negotiators to debate for retirement from 2010/11.
The committee classified different indicators considered for retirement on the basis of risk – those where there is a low risk that the reduction of associated activities would not be expected following removal. These were:
• CHD 5 - The percentage of patients with coronary heart disease whose notes have a record of blood pressure in the previous 15 months
• DM 5 - The percentage of patients with diabetes who have a record of HbA1c or equivalent in the previous 15 months
• DM 11 - The percentage of patients with diabetes who have a record of the blood pressure in the previous 15 months
• DM 16 - The percentage of patients with diabetes who have a record of total cholesterol in the previous 15 months
• STROKE 5 - The percentage of patients with TIA or stroke who have a record of blood pressure in the notes in the preceding 15 months.
Three indicators were deemed to have a high risk that patient care could be compromised if they were removed from the QOF, and the committee warned that ‘negotiators would need to consider the impact of removal of these indicators on activity':
• DM 22 - The percentage of patients with diabetes who have a record of estimated glomerular filtration rate (eGFR) or serum creatinine testing in the previous 15 months
• MH 4 - The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 15 months
• THYROID 2 - The percentage of patients with hypothyroidism with thyroid function tests recorded in the previous 15 months
GPC negotiators will also be forced to consider ways to eliminate double counting of QOF smoking indicators, after the committee ‘acknowledged that there are many interdependencies between the current set of smoking indicators in the QOF and the proposed new smoking indicator that had been prioritised as a potential new indicator for 2010/11.'
GPC chair Dr Laurence Buckman said: '‘We are concerned about the suggestion that some of the current indicators could be made redundant when they support vitally important care for patients with long term conditions.'
‘Removing such indicators risks undermining the high quality structured care many of these patients receive from their GP practice.'
‘They are also assuming there will be changes next year, which we don't think is helpful given that the main priority for GP practices should be preparing for the expected upsurge in flu cases this September.'
He added: ‘It's not the time to have to focus on yet more changes to the QOF. There have been a lot of changes in the last three years and we think it is time for a period of stability not a constant cycle of change.'
The QOF advisory committee shied away from setting maximum and minimum achievement thresholds, citing a lack of evidence to guide their decision and arguing that setting thresholds was ‘outside of their terms of reference'.
Both the 50th and the 75th centiles were considered as maximum thresholds, but ‘there was a lack of evidence as to what would happen to activity'.
It was suggested that a 75th centile threshold ‘would reflect a level of performance that is practically achievable for most practices and act as an incentive for improved performance', but the committee felt that practices in deprived areas would struggle to achieve it.Some QOF indicators could be retired