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At the heart of general practice since 1960

NICE puts lifestyle at core of new QOF

By Nigel Praities

NICE has placed primary prevention at the heart of its plans for a radical overhaul of the QOF, with proposals for GPs to be paid for promoting exercise and healthy eating.

Pulse has been given exclusive access to a list of 36 priority areas identified by the institute, including incentives for carrying out risk assessments and offering advice on consumption of fruit, vegetables and fish.

The proposals follow predictions revealed in Pulse that the reshaping of the QOF under NICE would focus it much more sharply on public health.

Indicators would pay GPs for providing high-risk patients with advice about exercise, eating their ‘five-a-day', fish and less fat, and for prescribing them low-dose statins.

A further set would pay GPs for not using medications in certain situations – for example reducing use of antibiotics and use antipsychotics in dementia.

Those proposals are likely to be controversial, as the first time GPs will have been offered incentives for rationalising their drug use.

The NICE QOF advisory committee came up with the priority areas after reviewing the institute's guidelines and they are already being assessed by the National Primary Research and Development Centre for inclusion in the framework.

Indicators would also support the Government's vascular screening programme by paying GPs to go through their practice lists and conduct risk assessments.

Dr Colin Hunter, chair of the NICE QOF advisory committee and a GP in Aberdeen, said the areas were still in development and many would not reach the next stage.

‘We are simply matching proposals that mostly came form NICE guidelines this time – because there was not much time to look at external stuff – and put them through for further consideration and piloting as necessary.

‘It is the next stage where we consider the outcome which is more important,' he said.

Twenty-eight of the proposed areas are lifted directly from NICE guidelines, in an effort to align QOF more closely with NICE advice.

The proposed indicators on primary prevention have received a mixed reception from GPs.

Dr Brian Dunn, lead GPC negotiator on the QOF, said GPs were already doing most of this work already and would do well with these kind of indicators.

‘The problem with NICE guidelines in the past was that there was never any resources to deliver them, so theoretically there is not a problem with this,' he said.

Other GPs are not so optimistic. Dr Terry McCormack, former chair of the Primary Care Cardiovascular Society, said the emphasis on prevention was welcome, but warned there was no evidence lifestyle advice worked.

‘You can click a box to say you have done this, but how can you prove the patient has been given meaningful advice?' he said.

Proposed new areas for indicators

Primary prevention
- Dietary advice in those at high-risk or those with CVD, including eating fish, fruit and vegetables and reducing fat intake
- Advice about physical exercise
- Prioritising patients for a risk assessment based on information in practice records
- Prescribing simvastatin 40mg in those at high-risk

Dementia
- Reducing antipsychotic use due to risk of stroke and death
- Providing information and carrying out checks in those on antipsychotics

Obesity
- Waist circumference to be used in patients who are not obese

Antibiotics
- Using no antibiotics or a delayed antibiotic prescribing strategy for self-limiting respiratory tract infections
- Explaining natural history of respiratory infections in those with self-limiting infections

Diabetes
- Using meformin as a first-line option in patients who are not overweight
- Blood pressure and cardiovascular risk checks using the UKPDS risk engine
- Use of statins and ARBs in certain patients

Smoking
- Percentage of smokers referred to a Stop Smoking service or given pharmacotherapy

Source: NICE

New areas for QOF Click here to read the full list

The full list of indicators

Indicators could include advising patients on how to eat healthily Indicators could include advising patients on how to eat healthily

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