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NICE pushes for QOF inequality indicators

By Nigel Praities

The QOF has failed to tackle health inequalities and should be reshaped to include specific indicators for narrowing the gap between rich and poor, NICE has said.

The institute will begin work next year on a large-scale review of the indicators in QOF and its views are therefore fundamental to its future.

Guidelines from the NICE public health advisory committee recommend GPs should be better incentivised to target and treat patients in disadvantaged areas.

They recommend paying GPs for searching their databases for patients who have failed to collect their prescriptions or come to follow-up appointments.

But the advice has met scepticism from GPs and comes despite a recent study in the Lancet showing QOF achievement between the least and the most deprived areas has narrowed from 4% to 0.8% since the contract was introduced.

‘The QOF needs to be modified to give GPs a greater incentive to find and treat those who are disadvantaged and at greatest risk of premature death from preventable conditions,' the NICE document said.

But Professor Martin Roland, director of the National Primary Care Research and Development Centre and one of the main architects of the QOF, claimed the evidence showed it was already reducing inequalities.

‘Our research fairly consistently shows financial incentives tend to reduce inequalities. GPs in deprived areas have worked hard to achieve high scores, with slightly higher amounts of exception reporting but not much,' he said.

Professor Roland said the QOF square root formula worsened inequalities and should be scrapped, but questioned proposals for GPs to proactively follow up patients: ‘GPs already send three written reminders for follow-up appointments - any more could be regarded as harassment.'

RCGP chair Professor Steve Field said although NICE shouldn't regard the QOF as the ‘be all and end all' for reducing health inequalities.

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