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At the heart of general practice since 1960

QOF revamp runs into difficulty

By Nigel Praities

NICE's controversial vision of the future QOF, which would sees GPs for the first time being paid based on medication they do not prescribe, has already run into problems.

The QOF advisory committee is looking at ways to cut antipsychotic prescribing in patients with dementia.

Under proposals considered by the committee, practices would have to provide more information about risks to patients and carers when antipsychotics were prescribed and regularly monitor symptoms, cognition and adverse effects.

But Professor Helen Lester, deputy director of the National Primary Care Research and Development Centre, told Pulse the proposal as it stands was seen as too complicated and had been sent back to the drawing board for further revision.

Another indicator aimed at reducing levels of antibiotic prescribing, in which patients with respiratory tract infections would only receive antibiotics if they were ‘very unwell', at high risk of complications or had signs of serious illness, has also failed to make it into the first set of pilots chosen from the list.

‘They won't all end up in QOF,' said Professor Lester. ‘In the piloting process we expect to lose about half, because some of the problems only become apparent when you get them into clinical practice,' she said.

Professor Chris Butler, professor of primary care medicine at the University of Cardiff and a GP in Mountain Ash, Glamorgan, welcomed the focus on driving down antibiotic use, but warned against including it in the QOF: ‘I have a fundamental problem with paying people extra to implement good practice.'

But Dr Gillian Jenkins, a GP in Bristol, said: ‘It is useful to have a base on which we can offer advice. On the whole, NICE guidelines are accepted.'

Professor Helen Lester: Back to the drawing board on controversial indicator proposals Professor Helen Lester: Back to the drawing board on controversial indicator proposals

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