Smoking quit rate targets set to be added to QOF
By Nigel Praities
Exclusive: GP leaders are on the brink of agreeing tough new QOF targets that would see practices paid according to how many patients they help quit smoking.
Outcome targets for improving quit rates are designed as the first of a series of public health measures, likely also to include new QOF points for alcohol misuse and obesity.
Government insiders said this week that negotiations between the Department of Health and the BMA over smoking cessation targets were at an advanced stage.
The revelation follows a report from the Commons health committee calling for a ‘radical revision' of the QOF to address inequalities by including public health outcome measures – including targets for smoking cessation.
Significantly, the BMA immediately backed the call and a source close to the DH said a deal was on the verge of being thrashed out that would see smoking cessation the first of a series of outcome measures used to revamp the QOF.
'It's not a done deal yet,' the source said. ‘But there is willingness on both sides.'
The Government is also looking at ways to give PCTs the power to target local public health priorities by picking outcome targets from a national menu.
The health committee report warned the Government was likely to miss its target of reducing health inequalities by 10% by 2010. ‘Tackling inequalities should be an explicit objective during annual QOF negotiations and should have measurable characteristics which can be evaluated over time,' it recommended.
‘The QOF should be adjusted so less weight is placed on identifying smokers and more on incentives to stop smoking,' it added.
The BMA issued a statement saying it ‘agrees with the committee these are the policies the Government should be focusing on'.
Dr Vivienne Nathanson, the BMA's head of science and ethics, said it was in favour of ‘tough targets' to ‘reward GPs who are successful in helping patients quit'.
‘It is essential the Government spends taxpayers' money wisely on projects that will work,' she said.
Dr Richard Vautrey, deputy chair of the GPC, expressed only lukewarm support for the plan: ‘Various LESs provide support for patients who want to stop smoking and I think we would rather that than placing them in the QOF.'
But the GPC is under pressure from NICE, which will start reworking the QOF from next month. The body signalled its intent in the 2007/8 review, submitting a proposal for a new indicator for the percentage of patients who quit smoking at four weeks.
This proposal was rejected by the QOF consensus panel at the time, because of the costs of equipment to test patients and a lack of evidence, but there is growing political pressure to reverse that decision.
The DH said: "We want to ensure practices continue to deliver improvements to care, including encouraging more effective interventions to help smokers quit.'
But Dr Kathryn Griffith, a GP in York and member of the QOF consensus panel, said: ‘Why is it our responsibility? Why should our income depend on our patients' choice to do legal things like smoking, drinking and eating?'Momentum grows for smoking outcome targets
Oct 2007: A proposal for new QOF indicator based on the percentage of patients who quit smoking for four weeks was submitted by NICE during the 2007 QOF evidence review
Jun 2008: NICE has been asked to revamp QOF to include more patient outcome and public health indicators
Feb 2009: A study showed direct payments to GPs of over £100 for each patient who quit for a year cost less per quitter than prescribing pharmacological therapy alone 
Mar 2009: NHS Bromley offers GPs and pharmacists a total payment of £45 if their patient quits, but still says its stop smoking four week performance target is ‘challenging'
Mar 2009: Commons health committee recommends ‘rewarding QOF points for success with smoking cessation, rather than simply identifying smokers'
Smoking: tough new targets for GPs are on the way Smoking: tough new targets for GPs are on the way
 Arch Intern Med 2009;169: 230-5