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QOF indicators set for threshold hike

Read the full list of indicators for which the Department of Health wants to see the upper thresholds raised to reflect the performance of the top quarter of practices from April 2013

CHD6 - The percentage of patients with coronary heart disease in whom the last blood pressure reading (measured in the previous 15 months) is 150/90 or less

CHD8 - The percentage of patients with coronary heart disease whose last measured total cholesterol (measured in the previous 15 months) is 5mmol/l or less

CHD9 - The percentage of patients with coronary heart disease with a record in the previous 15 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken (unless a contraindication or side-effects are recorded)

CHD12 - The percentage of patients with a history of myocardial infarction (from 1 April 2011) currently treated with an ACE inhibitor (or ARB if ACE intolerant), aspirin or an alternative anti-platelet therapy, beta blocker and statin (unless a contraindication or side effects are recorded)

CHD14 - The percentage of patients with a history of myocardial infarction (from 1 April 2011) currently treated with an ACE inhibitor (or ARB if ACE intolerant), aspirin or an alternative anti-platelet therapy, beta blocker and statin (unless a contraindication or side effects are recorded)

STROKE10 - The percentage of patients with TIA or stroke who have had influenza immunisation in the preceding 1 September to 31 March

STROKE12 - The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record that an anti-platelet agent (aspirin, clopidogrel, dipyridamole or a combination), or an anti-coagulant is being taken (unless a contraindication or side effects are recorded)

BP5 - The percentage of patients with hypertension in whom the last blood pressure (measured in the previous 9 months) is 150/90 or less

DM15 - The percentage of patients with diabetes with a diagnosis of proteinuria or micro-albuminuria who are treated with ACE inhibitors (or A2 antagonists)

DM18 - The percentage of patients with diabetes who have had influenza immunisation in the preceding 1 September to 31 March

DM26 - The percentage of patients with diabetes in whom the last IFCC-HbA1c is 59 mmol/mol (equivalent to HbA1c of 7.5% in DCCT values) or less (or equivalent test/reference range depending on local laboratory) in the preceding 15 months

DM2 - The percentage of patients with diabetes whose notes record BMI in the previous 15 months

DM28 - The percentage of patients with diabetes in whom the last IFCC-HbA1c is 75 mmol/mol (equivalent to HbA1c of 9% in DCCT values) or less (or equivalent test/reference range depending on local laboratory) in the preceding 15 months

DM30 - The percentage of patients with diabetes in whom the last blood pressure is 150/90 or less in the preceding 15 months

DM31 - The percentage of patients with diabetes in whom the last blood pressure is 140/80 or less in the preceding 15 months

COPD8 - The percentage of patients with COPD who have had influenza immunisation in the preceding 1 September to 31 March

HF3 - The percentage of patients with a current diagnosis of heart failure due to LVD who are currently treated with an ACE inhibitor or Angiotensin Receptor Blocker, who can tolerate therapy and for whom there is no contra-indication

CKD3 - The percentage of patients on the CKD register in whom the last blood pressure reading, measured in the previous 15 months, is 140/85 or less

AF3 - The percentage of patients with atrial fibrillation who are currently treated with anti-coagulation drug therapy or an anti-platelet therapy

SMOKE4 - The percentage of patients with any (or any combination of) the following conditions: coronary heart disease, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses, who smoke and whose notes contain a record that smoking cessation advice or referral to a specialist service, where available, has been offered within the previous 15 months

Readers' comments (8)

  • QOFs are targets. They create paperwork and red tape. They assume that doctors are ignorant of potential benefits to patients health and therefore need to reminded with a rather pathetic carrot. The pressure is to give medication even if there are some minor contraindications. Informed patient choice does not appear in the equation. All we are doing is moving patients down the conveyor belt only to come back 10 years later with baffling multiorgan problems.
    Why can't we trust doctors to do their best, pay them a decent capitation fee and stop all this pointless cheese-paring. We did not spend decades training and gaining experience to become automatons.

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  • Mark Struthers

    Hear, hear, Mark Aitken! QOF has made GPs look like a braying herd of donkeys in their pathetic pursuit of the carrot.

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  • Does the quality of results always reflect the quality of care? I think the answer to that is probably 'no'. Enough said.

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  • Agree with the points of my 3 colleagues.
    I assume a target has never been lowered because it was too high or there was no evidence for it?
    A cost cutting execise so we can get better a jumping through more and more hoops for no more money
    More work + Same money = income cut in real terms

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  • Really, is it all about cost cutting? Or perhaps it could be because you may want to get some of the actual advise/intervention that GPs are actually trained to do i.e deliver useful drugs, where appropriate. Quite franky, when the indicator you are being asked to improve upon eg. the AF one is so out of line with the available evidence 'AF3 - The percentage of patients with atrial fibrillation who are currently treated with anti-coagulation drug therapy or an anti-platelet therapy', and patient continue to have devastating strokes unmedicated, then as a citizen one really has to question why you need trained doctors at all. So the indicator, in order to spare GP blushes continues to promote antiplatelets as if they are risk free for bleeding, whilst keeping anticoagualation - the stuff that reduces risk of stroke by 64% outside the reach of patients at risk. And then GPs go on about supporting patients through divorce etc - for which I assume many have no training at all. Either you are doctors or just overpaid social workers (without the qualifications I might add). You really are going to have to say which, for we as a society possibly might just need fewer doctors who don't do any doctoring and spend the money on social workers who do social work.

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  • Do social workers actually receive any training other than in how to avoid work? Have you considered the fact that many patients bring their problems to us because other services are so inaccessible. Whenever I as a professional try to contact a social worker more than often their phone diverts to voicemail or I am informed they are all having lunch together. As Einstein said not everything that counts can be measured and not everything that can be measured counts. I spend an inordinate amount of time entering codes into a computer after each consultation to generate payment for the work that is clearly documented in the patients record. It seems that the fact I have spent 15 minutes on smoking cessation does not count unless I enter a code to indicate that this task has been undertaken. 87% of patients are happy with the service they receive from GPs I challenge you to find another profession that can deliver this kind of satisfaction. I spent 30 minutes trying to persuade an 80 year old lady to take an anticoagulant to prevent her having a stroke as a consequence of her AF - all to no avail. Therefore no QOF point for her. Patients can chose not to take advice just as patients choose not to vote. Perhaps we should introduce MPQOF make MPs earn 30% of their pay based on MPQOF points and set a 75% threshold for getting patients out to vote. I wonder how many MPQOF points they would achieve!

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  • I have no desire to enter a fight about social workers but Sunita's comments are insulting. The vast bulk of the medical profession do much more than they are paid for and remain highly trusted. I would not dare to suggest that social workers don't strive to do their best. Please be more considerate.

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  • Knee jerk reaction is to ask 'Anonymous' to swap workload and pay with a social worker?

    However, yes of course there will be Social Workers that avoid work, as there are people in any large organisation, but I imagine there more being worked into the ground as staffing cuts bite.

    Please don't tar everyone with the same brush.

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