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The war on 'easy' QOF indicators begins

The wait to see how NICE reshapes the QOF is over - out are indicators for recording BP, blood glucose and cholesterol and in are targets aimed at reducing health inqualities.

The wait to see how NICE reshapes the QOF is over - out are indicators for recording BP, blood glucose and cholesterol and in are targets aimed at reducing health inqualities.



Up until this week, all we had was hint, supposition and a healthy dose of speculation.

No one really knew what NICE would do with its newly granted power to shape the QOF in its own image.

Would we see a dramatic shift towards public health indicators, with GPs paid by the weight watcher, the quitting smoker and the reformed alcoholic?

Might the institute take up the Tories' proposal, and suggest paying GPs by their success at promoting general wellbeing, as measured by patient questionnaires?

And would the time come for the forgotten diseases of primary care – for osteoporosis, osteoarthritis, erectile dysfunction and peripheral arterial disease?

Any of those moves might have presented a clear statement of intent from NICE, but then maybe evidence-based organisations don't do statements of intent.

Instead, the institute has left us with a set of proposed indicators notable mainly for their lack of any obvious pattern.

Its first three proposed indicators are for tougher blood pressure control in diabetes, recording thyroid-stimulating hormone in patients with learning disabilities, and for offering information on contraception, conception and pregnancy to women with epilepsy.

Certainly, NICE shows little sign of any desire to blow with the political wind. No public health, no hard outcome measures, and none of the illnesses the charities and pressure groups have so urgently demanded be included.

It's either a gutsy refusal to be swayed by pressure groups, or a reckless disregard for its critics. Or maybe just an essentially academic organisation's professorial lack of awareness of the world around it.

But buried in the NICE proposals are some rather more interesting hints about what the future might look like.

It has proposed scrapping indicators for a record of blood pressure, blood glucose and cholesterol – the widely predicted war on ‘easy' indicators has begun.

And among the institute's proposals for future indicators to be piloted – under the labyrinthine new system for developing the QOF – are targets for looking after the physical health of patients with dementia and schizophrenia.

Together with the planned indicator for patients with learning difficulties, that seems to amount to a concerted effort to target the QOF at the most vulnerable.

NICE seems to be eschewing broad population benefits in favour of using the QOF as a targeted tool to narrow health inequalities.

Richard Hoey

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