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Analysis: Bundling indicators is not a solution

The first rule in using medical information is that you should only use it for the purpose for which it was collected in the first place. It is worth bearing that in mind when comparing the results of the National Diabetes Audit with the results from QOF.

In some areas, such as BMI measurement they are quite similar. In others, including blood pressure measurement, they can be very different.  While data used by the QOF has been honed by practices, there is little such effort towards the NDA so the results are poorer.

There is political pressure for a single ‘bundle’ of QOF indicators for patients with diabetes who have received all nine of the care processes although this is not part of the NICE menu of indicators the Government has announced it plans to impose from next year.

There are already bundled indicators – prescriptions for new heart attacks and blood tests in dementia but the current form of QOF makes bundles difficult to implement. It can be difficult for practices to see how they are doing against such a complex indicator. Its all-or-nothing nature can give little indication of what still needs to be done for a patient. 

It would herald a new type of QOF and practices would have to work much harder to ensure patients turn up for checks.

Dr Gavin Jamie is a GP in Swindon, Wiltshire, who runs the QOF Database website


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