The consultation from NICE on the proposed indicators for the 2014/15 QOF, unlike the main contract ‘consultation’, is open to everyone, so firstly I would encourage GPs to read it and send their thoughts back. I will be doing so in the next couple of weeks, and will put my response online as well.
We are well away from the stage of allocating points and thresholds. Many of the indicators in last year’s consultation did not make the final menu. We cannot say if any of these will be attractive to practices – the consultation is largely about whether they are workable.
Many of the indicators are simple, like the two level blood pressure measurements that we have seen this year in diabetes. Clearly this is felt to be a success.
Some of the other indicators, such as carrying out health checks in dementia carers, could be very complicated. The consultation says that every patient with dementia will have to have a named carer. It is not clear if this would apply if the patient was in a nursing home or did not have a member of the family as a carer. It has been modified since earlier drafts to allow for the fact that patient’s carers may not be registered with the same surgery as the patient. Some patients with very mild dementia may not have a carer at all.
Similarly coding patients who are carers will create some debate around the exact definition of the role. This is probably workable but complex – especially if the number of patients diagnosed with dementia explodes after screening tests.
The ‘tightly-linked’ cholesterol measure appears again after inclusion in last year’s consultation – definitely the most complicated indicator ever suggested for QOF. It is impossible to implement with the current rule setting. This may be possible under the new GPES/CQRS but it will remain very complex for practices, with some strange quirks caused by that complexity. More clarity of thought is needed here; and as stated earlier, it may not make the final cut.
Dr Gavin Jamie is a GP in Swindon, Wiltshire, and runs the QOF Database website.