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GPs buried under trusts' workload dump

QOF set for reshape in NICE image

By Daniel Cressey

The QOF is set to be radically reshaped to bring it directly in line with NICE guidance, a leading expert claims.

GPs have also been warned to expect a raft of new indicators in areas such as cardiovascular screening and osteoporosis.

Dr David Jenner, QOF lead for the NHS Alliance, told an Alliance conference that NICE would be the key driver to QOF revisions. He predicted indicators would be judged over 12 months rather than 15 and targets tightened for blood pressure control.

NICE said it would be pushing for its guidance to be incorporated into the QOF at the next revision.

And Dr Jenner claimed there was still scope for significant stiffening of indicators in this year's review – despite promises of 'minimal changes'.

Dr Jenner, who is a GP in Cullompton, Devon, said: 'Most of the NICE evidence represents national priorities. I have little doubt they will be priorities – the Department of Health will want them and the evidence base will be there.'

He added: 'Minimal change doesn't mean no change. There is room to raise thresholds to what people are actually achieving – it's logical in a performance framework to raise the bar.'

Dr Jenner predicted the QOF would follow NICE in introducing a 140/90mmHg blood pressure target. Micro-albuminuria, eGFR and cholesterol testing would all be measured over 12 months.

He also said the diagnostic thresholds for COPD could shift, from an FEV1 of under 70 per cent of predicted to less than 80 per cent of predicted, meaning more patients would qualify for inclusion on registers.

In a statement, NICE told Pulse: 'It would be correct to state that we do want to see the QOF in line with NICE guidance wherever possible. In the next round of QOF changes, we will review the guidance against the new priority areas and liaise with experts to identify the most relevant indicators.'

Dr Robin Hollands, a GP in Cheltenham and QOF lead

for Gloucestershire LMC, said some simplification of the QOF would be welcome. But he added: 'It could increase work – that is a concern.'

dcressey@cmpmedica.com

Predicted changes to QOF

Screening

• Screening BMI>30 for diabetes and CHD

• Bowel cancer and mammography

Obesity

• Protocol for advice and support to overweight

Cardiovascular

• CVD risk assessment including HDL/LDL and glucose for all

>40-50 years

• Use of ß-blockers in heart failure

• Risk assessment in atrial fibrillation

• Clopidogrel for acute coronary syndrome

• Two years' dipyridamole use post-cardiovascular event

COPD

• Inhaled steroids/long-acting bronchodilators where FEV1 <>

• Self-care plans (also for asthma)

Osteoporosis

• Care after low-impact fractures

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