New QOF review chair looks to eliminate 'easy points'
By Lilian Anekwe
QOF indicators with high achievement and low exception reporting will be first to face the axe in the coming review, the GP appointed to lead the process has told Pulse.
The comments cast doubt over the future of indicators such as BP1 and BP4, for having a register hypertensive patients and a record of blood pressure, CHD10 for prescribing a beta blocker to patients with coronary heart disease, which GPs have scored highly in across the board.
Professor Helen Lester, deputy director of the National Primary Care Research and Development Centre, was unveiled by NICE last week as lead GP in the team to review the QOF for cost-effectiveness and pilot new clinical indicators.
Professor Lester's appointment, and that of another GP, Dr Colin Hunter, as chair of NICE's QOF indicator advisory committee, will ease fears that the new QOF will be imposed on general practice from the outside.
But Professor Lester, speaking to Pulse immediately after her appointment, said a key part of her role would be in laying the groundwork for a rolling QOF, in which old indicators are retired and new ones introduced.
She said she would be applying a series of tests to identify indicators now embedded in practice and no longer needing incentivising: ‘It would be an indicator with high achievement across all practices and low exception reporting. Those are the sort we would look at in more detail to see if it were safe to remove them, with the caveat that achievement in them should still be tracked.'
Professor Lester's team for piloting indicators will include members of the University of York's health economics consortium and the RCGP.
‘NICE has asked us to develop 10 new indicators a year,' she said. ‘Work will start on 1 October, piloting indicators over six months in 30 practices. In April 2010 we will begin piloting the next tranch in another 30.'
She said the review team would test indicators across a wide range of practices – ‘from single-handed to multi-practitioner, in deprived and affluent areas' – and would be rigorous in weeding out targets that did not work in the real world.
‘We think we'll have to develop 25 indicators and pilot 15 to get five at the end. The first set will be decided by the advisory committee in June, so we have a busy summer ahead.'
As QOF indicator advisory committee chair Dr Colin Hunter, a GP in Aberdeen for 23 years, will help decide which indicators are piloted and handed to the GPC and NHS Employers to be negotiated on.
Dr Hunter helped thrash out the original QOF in 2003 and told Pulse he would not meekly tow the NICE line: ‘It's important external stakeholders and negotiators don't interfere. We need to have independence and autonomy and I'm not one to be bullied.'Biography: Professor Helen Lester
New role: Chair of external contractor for QOF review
• Professor Helen Lester is deputy director of the National Primary Care Research and Development Centre and was formerly co-chair of the QOF indicator expert advisory panel. She has been a GP in an inner-city area of Birmingham since 1991 and has a special interest in mental health.
New role: chair of the NICE QOF indicator advisory committee
Dr Colin Hunter has practised in Aberdeen for over 20 years and is honorary treasurer of the RCGP, having formerly been chair of the college's Scottish Council. He was heavily involved in drawing up the original version of the QOF during the GMS contract negotiations in 2003/4.