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Hike in QOF upper thresholds will deter low-achieving practices, says top NICE adviser

Exclusive Government plans to raise the upper thresholds for QOF indicators from next month could disincentivise low-achieving practices and lead to ‘unintended consequences’ in the care of patients, warns the chief QOF adviser at NICE.

Dr Colin Hunter, chair of NICE’s QOF Independent Advisory Committee, said it was important the Government thought carefully about the move in England as it could have wide-ranging effects and that such changes required careful monitoring and review.

The intervention from Dr Hunter will pile pressure on the Department of Health to reconsider its proposal to increase the upper thresholds for 20 QOF indicators to match the achievement of the top 25% of GP practices from April, and for all other indicators from April 2014.

The GPC has already warned that QOF exception reporting guidance should be revised so GPs are not blamed for ‘inflated’ exception reporting rates if the Government proceeds with its plans to hike upper thresholds.

GPs in Wales, Scotland and Northern Ireland have all been spared the the full force of the changes in upper thresholds, and the Family Doctor Association has also asked for a delay to the changes in England.

In an exclusive interview with Pulse, Dr Hunter said: ‘It’s a complex area, there can be pros and cons. You may actually disincentivise some of the less well achieving practices to do quality care. It’s important this issue should be considered by Governments and negotiators.

‘I think when you make changes such as this it’s important to analyse the potential unintended consequences and then observe very carefully what’s happening to ensure those unintended consequences aren’t happening. If they do occur then you need a review of what’s been done further down the track.’

Dr Hunter also hit back at the GPC’s criticism that the new hypertension QOF indicators, proposed by the NICE committee and set to be placed in the framework from April, are ‘dangerous’ and would put patients at risk of polypharmacy and hypotension.

He said: ‘All indicators we look at have a strong-evidence base, so I don’t know what the GPC would base that analysis on. We are confident when we look at indicators that come from NICE guidance or from SIGN guidance or from quality standards.’

But Dr Richard Vautrey, GPC deputy chair, said: ‘The problem is combining the introduction of more challenging targets with raising the thresholds.

‘The NICE group gave advice on the former, but the contract imposition could add the latter. It is this combination that creates problems. We know that pressure to chase targets means that quality can sometimes suffer.’

Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

Review all the changes being made to QOF and look at them from a business standpoint, with expert Dr Gavin Jaimie at Pulse Live, our new two-day annual conference for GPs, practice managers and primary care managers.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.

Readers' comments (4)

  • Where's the rest of the article, it ends mid sentence??

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  • Good point! The final line has been reinstated now

  • Trouble with NICE guidance is, it has no space for common sense.

    I have a 74 years old with cholesterol of 5.2 and Qrisk2 of 20%. He has moderate dementia, in NH, with poor quality of life. Sure, I can start statin, do LFTs, tell him to put up with muscle aches and lethargy or even try several other statins. I can ask the home to put him on low fat diet even though they are concerned he isn't eating enough. I might even tell him all these would be recommended even if I didn't believe it. I would be a good GP in the box ticking government's eyes. Will t really benefit my patient? Will really?

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  • Hang on here I thought NICE set the QoF targets? Is Dr Hunter saying that its the DoH that actually set them???

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  • DoH will not change the targets if it does not tally with their agenda.save money at all costs!

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