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GPs don't trust NICE to rework QOF

GPs deeply distrust NICE to rework the QOF and fear its intervention could seriously damage the quality of GP care, a Pulse survey reveals.

Nearly three quarters of GPs felt the institute was unsuited to its planned role in reviewing the QOF, with particular concern over its intention to withdraw indicators judged to be ‘embedded' in practice.

Their warnings came as a new study was the latest to find that improvements in care in clinical areas outside the QOF lag well behind those with incentives.

Some 56% of the 270 GPs who responded thought plans to use NICE to overhaul the QOF would harm patient care, with a similar number having specific concerns over the removal of indicators.

Some 70% of GPs said areas outside the QOF got neglected as a result.

One GP who wished to remain anonymous told Pulse: ‘Having worked with NICE on guidelines I know their systems are ill suited to ensuring targets are capable of implementation in primary care.

‘Indicators embedded in practice still require funding for the work to be carried out but this will be shifted to new indicators. This means either that the indicator is no longer followed or resources are transferred from other areas of care.'

QOF researchers found that although the overall level of care delivered for five conditions improved over recent years, care improved much more rapidly for QOF indicators – recording of blood pressure, smoking status, cholesterol and BMI – than recording of a non-QOF risk factor, alcohol consumption.

A study of 315 Scottish practices between 2000-1 and 2005-6 found the overall increase in the rate of recording of risk factors in five conditions incentivised by the QOF was 19.9 percentage points, compared with 5.3 percentage points for alcohol consumption.

Study leader Professor Matt Sutton, professor in health economics at the University of Aberdeen, concluded: ‘As we might expect, responses were greater on indicators that attracted more payment and required more stringent performance.'

The study was published online by the Journal Health Economics.

GPs don't trust NICE to rework the QOF, a Pulse survey of GPs has found Our survey said…

Do you believe removing indicators ‘embedded in practice' will have a detrimental effect on patient care?
Yes 55% No 18% Don't know 27%

Do you believe clinical areas outside the QOF get neglected as a result?
Yes 70% No 24% Don't know 6%

Is it appropriate to apply cost-effectiveness criteria to the QOF?
Yes 41% No 36% Don't know 23%

Should the proportion of income earned from QOF:
Increase 17% Decrease 37% Stay the same 46%

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