GPs will be allowed to use home BP monitoring instead of having to invest in expensive ambulatory monitors under a redrafted QOF indicator recommended by NICE.
The change comes in a list new QOF indicators they intend to recommend to negotiators this year, and comes after some GPs said that ambulatory blood pressure measurement is not suitable for some patients and investment in ABPM machines would be a significant outlay for some practices.
As expected, NICE also recommends tightening the blood pressure goals for patients with vascular disease (peripheral arterial disease, coronary heart disease and stroke/TIA) to 140/90 mmHg, in line with the the targets for patients with hypertension, although this has caused some concern over increased exception reporting - rates went up considerably in the pilots across all three disease groups and although the QOF panel acknowledged thresholds for points would need to be set low, leading GPs have questioned the likelihood of this with the current trend towards ever higher achievement thresholds.
Other new indicators up for negotiation include giving women with diabetes pregnancy advice, referring patients with suspected dementia to memory clinics and recording the contact details of a named carer for each patient diagnosed with dementia.
The upper age limit for offering preconception advice to women with epilepsy indicator is to be lowered from 55 to 45 years (bringing it in line with the new one for women with diabetes), while the timing of blood tests for patients with a dementia diagnosis will be switched to the 12 months preceding entry on the register rather than six months either side, to bring it in line with new indicator for diagnosis through specialist memory assessment.
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In full: NICE recommendations for new QOF indicators in 2014/15
And after complaints about having to repeatedly ask about erectile dysfunction in men with diabetes, even when the condition has already been identified and all treatment options have been exhausted, there will now be an exclusion code for patients with previously identified erectile dysfunction so they are spared further questioning about it.
The ten indicators will be put forward for negotiations between the GPC and NHS Employers this year, although talks broke down last year and the full menu of indicators was imposed on English GPs, with some concessions in the other UK countries. Click here to download the full list of indicators proposed.
Professor Gillian Leng, deputy chief executive and director of health and social Care at NICE said: ‘All of the proposed new indicators are based on the best evidence and have been developed in consultation with professional groups, patients and community and voluntary organisations.
‘They have also been tested across general practice to make sure they work. The independent QOF Advisory Committee has carefully considered the indicators before recommending them for inclusion in this final menu, and we are confident they will improve patients’ health.’
Dr Colin Hunter, QOF Advisory Committee chair and a GP in Aberdeen, said: ‘The independent QOF Committee has thoroughly deliberated on all of the evidence, consultation responses and feedback from piloting, so we believe that the ten proposed indicators that we’ve put forward on today’s menu will improve the care that GPs provide for their patients.
‘Our independent Committee is made up of healthcare professionals and lay members with a wide range of expertise. This depth of experience is invaluable in helping us reach robust clinical decisions on indicators that are practical for GPs to undertake, and that we expect will be essential for improving the quality of patient care.’
