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NICE review of QOF to crack down on 'double counting'

By Lilian Anekwe

Exclusive: NICE plans to radically reduce the number of cardiovascular indicators in the QOF to avoid paying GPs twice for care in overlapping areas, Pulse can reveal.

The move follows growing disquiet among ministers at ‘double counting' in the QOF, with Pulse revealing in August last year that the Government wanted to cut down the number of ‘easy points'.

NICE is now examining ways of putting the clampdown into practice as part of its wide-ranging review into the cost-effectiveness of the QOF.

Jennifer Field, assistant director of costing at NICE, told delegates at the first national QOF consultation event in London last week: ‘What we don't want is double counting. We don't want to incentivise for care that's already being delivered elsewhere.

‘For example, patients being newly diagnosed with angina – you won't get paid for giving them statins if they are on statins for another condition.'

The Department of Health is also believed to be concerned about overlap between hypertension, coronary heart disease and diabetes indicators (see box, left), and has already moved to reduce double counting among smoking indicators.

Dr Kathryn Griffith, chair of the Primary Care Cardiovascular Society and a GP in York, said:

‘I can understand where they are coming from – if a patient is on the CKD register should you also get paid if the same patient is on the hypertension register? The problem is, the more conditions you have the more difficult you are to treat. But GPs don't get more if a point is more difficult to achieve.'

GPC negotiator Dr Peter Holden warned the Government against trying to remove money from QOF funding without using it in other areas of general practice.

He added: ‘Double counting as it existed, for things like smoking status, has gone and there wasn't much in the first place. No part of the QOF is purely target-based – a lot of it is there to pay for the resources you need to provide care.'

Pulse has also learned that NICE will turn its attention to exception reporting under its review, and will consider scrapping it altogether or setting target thresholds at closer to 100%.

Advisory documents, given to NHS managers, recommend reducing the number of reasons for which patients can be exception reported and raising achievement thresholds for key clinical indicators.

‘One of the things we will be looking at is if we're not going to exception report patients, perhaps we should set the maximum threshold higher – at 90-95%,' Ms Field told delegates.

Catherine Jenkins, head of the quality team at the Department of Health, warned: ‘Exception reporting detracts from the net benefit of an indicator,' adding that indicators with high levels of exception reporting risked failing to meet cost-effectiveness criteria and being dropped from the QOF.

But Dr Paul Frisby, a GP at a practice in Eastbourne with three times the national average of elderly patients, said ministers failed to understand that exception reporting could sometimes be good for a patient's health. ‘Because it's looked on in a derogatory way it's not seen as representing good care,' he said.

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