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QOF to get tougher, go local and focus on public health

By Lilian Anekwe

GPs face a radical reshaping of the QOF, with tougher targets based increasingly on outcomes rather than processes, and a new focus on public health.

NICE will be handed a key role in setting new indicators, in a move to align the QOF with the targets and recommendations set in its guidance.

The Government's primary and community care strategy, launched as part of Lord Darzi's NHS Next Stage Review, includes plans for a new independent body, which would consult with NICE to review and recommend indicators in the QOF.

The move has raised fears that GP negotiators could be frozen out of the process for deciding on new indicators – and could see tough new targets imposed on the profession.

In another radical move, the strategy suggests PCTs will be given more powers to implement local QOF targets, perhaps by choosing from a national menu of indicators.

A Department of Health spokesperson said the type of indicators included in the QOF would change, to ‘move away from rewards for measuring to rewards for health benefits'.

GPs would also be expected to help patients to achieve key public health targets, such as weight loss, smoking cessation and reducing alcohol consumption – with the proportion of the framework devoted to public health set to increase from 5% to 15%.

The spokesperson added: ‘The aim is to have an independent body that decides what the priorities are, but we'll have to discuss with the professions and NICE how we do this.'

Dr Richard Vautrey, deputy chair of the GPC, said: ‘There is already an independent QOF expert review panel, and all its evidence is publicly available – I fail to see how it could be more transparent. We believe it would be short-sighted to move from the current system.'

Primary care academics said a move to increasing numbers of outcome targets would not necessarily be an effective use of QOF indicators.

Professor Helen Lester, chair of the QOF expert review panel, said: ‘It is perhaps fairer to judge quality of primary care through a judicious mix of process and intermediate outcome measures.

‘The further away an event is from what happens in the consultation, the less relevant and meaningful it is as a measure of the quality of care given by the primary care team.'

Professor Martin Roland, director of the National Primary Care Research and Development Centre, warned not all indicators could be assessed using outcome measures.

‘Things such as cholesterol and blood pressure are easier to assess in terms of outcomes because you can measure the impact in terms of outcomes. But I would approach measuring things such as obesity, with outcomes such as weight reduction, with a degree of caution.'

lanekwe@cmpmedica.com

Plans for a new-look QOF

• A fresh strategy for developing the QOF will include an independent and transparent process for developing and reviewing indicators
• Greater role for NICE in developing and reviewing
clinical indicators
• Reduction in the number
of organisational or process indicators in the QOF to focus
on prevention and greater
clinical effectiveness
• Greater flexibility for PCTs to select quality indicators from a national menu that reflect local health improvement priorities
• More resources for tackling obesity, reducing alcohol harm, treating drug addiction, reducing smoking rates and improving sexual and mental health
Source: NHS Next Stage Review, primary and community care strategy

GP negotiators could be frozen out of the QOF process GP negotiators could be frozen out of the QOF process

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