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The Commissioning Outcomes Framework explained in 500 words

What is it?

The list of indicators which will be used by the NHS Commissioning Board to measure the quality and outcomes of healthcare commissioned by Clinical Commissioning Groups from April 2013.

Developed by NICE, the Commissioning Outcomes Framework (COF) is intended to provide clear, publicly available information on the quality of healthcare services commissioned by CCGs - including patient-reported outcome measures and patient experience - and their management of NHS resources.  The framework is also intended to capture progress in reducing health inequalities.

GPs’ quality payment is also linked to COF attainment as well as their CCG achieving financial balance and delivery on the NHS Constitution.

What is rationale behind it?

The COF will allow the NHS Commissioning Board to identify the contribution of CCGs to achieving the priorities for health improvement in the NHS Outcomes Framework, while also being accountable to patients and local communities. It will also enable CCGs to benchmark their performance and identify priorities for improvement.

Where is it, in terms of development?

NICE published the first 44 COF indicators recommended by its 20-strong advisory committee on August 1 2012. These were developed from NICE quality standards, the NHS Outcomes Framework and from other existing indicator collections such as national audits.

A selection of final indicators is now being prepared by a committee which includes 5 GPs as well as hospital doctors, patients and commissioners and will be considered by the NHS Commissioning Board shortly for inclusion in the 2013/14 COF.

The indicators published so far cover cardiovascular, gastrointestinal, respiratory, mental health, endocrine, nutritional and metabolic, maternity and reproductive cancer and tumours among other categories.

As NICE publishes more quality standards, the range of clinical topics in the COF will develop. NICE is set to produce 150 quality standards within the next five years.

What are going to be the tricky bits to digest/get agreement on?

All COF indicators are subject to full public consultation and subject to feasibility testing by the NHS Information Centre so face inbuilt hurdles before publication. Critics say those produced so far focus largely on long-term conditions and treatment while neglecting prevention.

There are some gaps in the 44 indicators proposed so far - for example, children and young people and learning disabilities are poorly covered while there is a slant towards other areas such stroke.

According to the Kings Fund, the gaps partly reflect a lack of evidence and/or data, or problems in reliable statistical measurement of indicators at CCG level. They warn that in the interim the assessment of CCG performance can therefore only be partial and could carry the risk of distorting CCG priorities.

In addition, how the COF will work in practice remains to be seen. The final list of indicators timetabled for this autumn has yet to emerge. The extent to which PROMs will play a part has yet to be revealed. The rewards and penalties linked to the framework have yet to be specified.

Lastly, it´s still not clear how the aspiration of judging CCG performance on reducing inequalities will be achieved - or what the relationship between the COF and the NHS Commissioning Board´s own targets set out in its mandate will be.

Alisdair Stirling is a freelance journalist

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