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GPs face tougher diabetes targets as NICE puts 'bundled' QOF indicator out for consultation

GPs face only being paid for annual checks in patients with diabetes - such as blood pressure and kidney function - if they are able to carry out a list of eight assessments all in a single patient, under proposed changes to QOF put forward by NICE advisers.

Under a consultation begun today, NICE revealed it will push ahead with controversial plans to reform the diabetes indicators in QOF worth £5,000, making it harder for practices to gain points.

NICE proposes a ‘bundled’ QOF indicator in diabetes for the 2015/16 contract, which would see practices completing a series of eight annual checks before they are awarded points.

The proposed new indicator would include checks on BMI and blood pressure, blood glucose, cholesterol and kidney function tests as well as foot examination and smoking status.

The NICE primary care QOF advisory committee originally rubber stamped development of a composite indicator last year, under pressure from the Department of Health to find a way address reportedly low completion of all annual checks in the National Diabetes Audit.

The proposal provoked a backlash from the GPC, which argued the National Diabetes Audit data underestimates GPs’ performance and that a bundled indicator would be ‘demotivating’ for GPs.

A Department of Health review concluded differences in read codes for key process indicators accounted for much of the disparity between QOF and NDA figures, but nevertheless backed the introduction of a bundled indicator.

Proposed new bundled diabetes indicator

The percentage of patients with diabetes who have had the following care processes performed in the preceding 12 months:

·         BMI measurement

·         BP measurement

·         HbA1c measurement

·         Cholesterol measurement

·         Record of smoking status

·         Foot examination

·         Albumin: creatinine ratio

·         Serum creatinine measurement

In full: NICE proposed indicators for 2015/16 QOF 

The proposed indicators also include new points for alcohol screening in patients with hypertension, identifying older patients who are prescribed multiple medications and giving women with serious mental illness advice about contraception.

NICE said the new list of 10 potential indicators has been developed following recommendations from the QOF committee meetings, and indicators are currently being piloted in representative practices across the UK to test their feasibility and acceptability.

Professor Gillian Leng, health and social care director at NICE, said: ‘This consultation on potential new indicators is an integral part of NICE’s process for QOF. It provides the opportunity for everyone with an interest to contribute to the development of indicators for the 2015/16 Quality and Outcomes Framework. We value this input highly and all feedback will help the QOF Advisory Committee decide which indicators will be put forward for publication on the NICE menu for the QOF.

‘The final menu of indicators, expected to be published on the NICE website in August 2014, will support healthcare professionals to improve the quality of patient care, based on the best available evidence.’

Dr Gavin Jamie, a GP in Swindon who runs the QOF database website, told Pulse the bundled indicators ‘were complicated’ but could be relatively easily achieved in one visit.

But he added that a number of these measurements have recently been removed from the QOF – such as measurement of albumin to creatinine ratio (currently DM005) which is set to be retired from April, while BMI (formerly DM2) and serum creatinine or eGFR (DM22) measurements that were taken out for 2013/2014.

Dr Jamie said: ‘In many cases the measurement targets had been taken out, so this adds them back in.

‘Also there are a number of hypertension indicators and you’d need to add in quite a few points for that. And the polypharmacy indicator review is bringing back medication reviews that were in the organisational domain.’

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Readers' comments (7)

  • It seems that the NICE/NHS-E cabal won't play with a straight bat (or without tampering with the ball).

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  • No...NICE propose to do this to increase the number of patients that receive the core processes, not because they' ve decided they want "to make it harder for practices to gain points."

    That may be an effect of the change, that Pulse spin is inaccurate speculation as to another organisation's motives.

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  • Point taken - that sentence has been reworded

  • Let common sense prevail

    Can anyone explain to me the rationale behind this development?
    The QOF is effectively an incentive scheme to promote high quality clinical practice. To make the required parameters difficult to achieve acts as a disincentive for practices to invest the time and resources (staff, training, money) required to provide that high level of care.
    How perverse is it to design a disincentive scheme???

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  • They have just removed bmi, renal function, acr from qof ,

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  • Dr Mustapha Tahir

    This tick box culture brought by QOF, such as ticking a box for foot examination, reminds me of what Professor Albert Einstein once wrote "Two things are infinite: the universe and human stupidity, and i am not sure about the universe".

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  • Vinci Ho

    Data from NDA basically said the care provided by GPs on diabetics was crap and it was on national news. This is hence the typical reflex action. But then the philosophy is if it was really that crap , will bundling 8 parameters into one actually make the outcomes with these diabetics substantially better? Perhaps that might happen if NHSE allocated a diabetes specialist nurse to every practice or two , not with this bundling!

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  • If you achieve 7/8 indicators then it will cost you money to collect them with no income to offset those costs. The safest option is to stop measuring ANY of them. I wonder how they will like that option ?

    It needs to be coordinated by the BMA.

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