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Exercise QOF indicators are workable, says NICE development lead

Exclusive New QOF indicators incentivising practices to promote more active lifestyles are proving ‘very positive’ in pilots, claims the NICE’s development lead.

Professor Helen Lester, NICE’s clinical QOF indicator development lead, told Pulse that practices piloting the exercise indicators in patients with hypertension have embraced the challenge and come up with some innovative ideas for making it work.

The claim comes after the GPC said several of the QOF indicators incentivising practices to promote better lifestyle choices that Government wants to impose on practices were ‘unworkable’.

The indicators for 2013/14 include assessing exercise levels annually in patients with high blood pressure, and delivering a brief intervention in those who are considered ‘less than active’.

It also comes after NICE released draft guidance that said GPs should screen all adults for their exercise habits and offer advice to those not sufficiently active and its advisors agreed to pilot new QOF indicators for alcohol screening.

Professor Helen Lester, who is also a GP in Birmingham, said the results of pilots of the exercise indicators were positive.

She said: ‘The reports from the pilot practices that engaged with the indicators were generally very positive. It is a new way of working, certainly, but just because it is a new way of working doesn’t mean that it is a bad way of working.’

She said practices were coming up with ideas, such as having an exercise facilitator come in for one session a week, having a guided walk around their local area, and that they were helping patients understand just how many steps they had to do and how hard they had to work in terms of getting their heart rates up.

She added: ‘Primary prevention is definitely part of our role so I think you are on very thin ice to argue that it is not our role to prevent people from becoming ill. It absolutely is, otherwise we should now immediately stop suggestion people should not smoke.’

Professor Mike Kirby, a GP in Radlett, Hertfordshire, and professor of medicine at the University of Hertfordshire, said he supported the idea as it could have a similar effect to presciring lipid-lowering ht

He said: ‘I have always been a believer in that prevention is better than cure. With the QOF, if you incentivise practices to do things they are often very well placed to do it. Exercise can be as effective as a statin drug in preventing heart attacks and strokes.’

But Dr Richard Vautrey, GPC deputy chair, said that the introduction of the indicators went too far.

He said: ‘I think we need to be careful not to simply expect GPs to solve society’s problems by putting more and more public health measures into QOF. There are many other ways to tackle public health issues, not necessarily expecting practices to do that.

‘For instance one of the best ways to tackle alcohol issues is to raise unit pricing rather than asking practices to do more and more surveys and questionnaires.’



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