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Half of QOF clinical targets to be scrapped

By Lilian Anekwe

EXCLUSIVE: The QOF is to be torn up and rewritten, with plans to scrap almost half of clinical indicators within the next four years and replace them with new work.

Among the indicators set to come under intense scrutiny are those for statin treatment in coronary heart disease and for retinopathy screening.

A consultation document, published by the Department of Health last week, sets out a blueprint under which NICE will radically reshape the QOF on the basis of cost-effectiveness.

The institute is to evaluate 88 of the 92 clinical indicators over the next three to four years, at a rate of 20 to 30 indicators a year.

NICE has been handed sweeping powers to reshape the QOF from April 2009, and will manage the development and piloting of 10 new indicators a year, to be negotiated on by the GPC and NHS Employers.

The consultation document makes clear almost the entire QOF will be reviewed for cost-effectiveness – as revealed by Pulse in September – with indicators judged not to deliver value for money jettisoned.

Current indicators deemed to have become part of standard practice will also be ‘retired' – with all replacement targets designed to embed new work into general practice.

‘It is not, in our view, sustainable to expand the QOF to reflect the latest evidence,' the DH document states. ‘Our view is that it should continuously evolve, with some indicators being replaced, for example where an activity has become part of standard practice.'

A report on the QOF due to be published next month suggests rewards for prescribing statins to lower cholesterol in patients with coronary heart disease could be among the first to be downgraded.

The research, by independent social policy think-tank Civitas, found the indicator was not sufficiently linked to health gain to justify its cost.

The intervention saves a maximum of 14 lives per 100,000 of the population a year, compared with warfarin for atrial fibrillation, which saves a maximum of 33 lives.

An average practice earns £2,760 for prescribing statins in CHD and £2,400 for prescribing ACE inhibitors to patients with heart failure. But use of ACE inhibitors for heart failure saves 308 lives per 100,000 – nearly 10 times as many as the statin indicator.

A report for the DH, conducted by primary care researchers at the universities of York and East Anglia and cited in the

consultation document, found diabetic retinopathy was also unlikely to be deemed cost-effective.

‘The net monetary benefit of retinopathy screening is negative and thus it is not a cost-effective use of resources,' the report found.

But James Gubb, director of the health unit at Civitas and author of its report, criticised the handing of power over to NICE.

‘Turning over responsibility for future QOFs to a quango concerned with crude economic calculations is unlikely to be the way forward,' he warned.

Dr Richard Vautrey, deputy chair of the GPC, said: ‘We'd want to understand in more detail how NICE intends to apply cost-effectiveness measures to primary care.

‘It would be hard to build a case that interventions at the primary care level were not cost-effective.'

Half of QOF targets are to be replaced within the next 4 years

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