By Lilian Anekwe
NICE has bowed to Government pressure to include more public health outcomes measures in QOF, and have requested GPs are measured on quit rates for smoking cessation in future.
Despite controversy over the limited influence GPs can have over patient outcomes, NICE has come under pressure from the Government that wants 15% of practice income to be derived from achievement in public health, with a heavy emphasis on outcomes measures.
At a meeting this week, the primary care QOF indicator advisory committee reviewed the results of pilots of indicators in smoking and, despite opposition from pilot practices, took the controversial step of requesting future QOF smoking cessation indicators should be based on quit rates.
The committee recommended three new smoking cessation indicators for negotiation by the GPC and NHS Employers (see box below), for inclusion in the 2012/13 QOF, after they were successfully piloted. These will not contain the controversial new quit rate targets, but the committee agreed that in future years GP practices should be paid on the basis of quit rates and acknowledged calculating payment will be 'complicated' as practices in deprived areas with low quit rates would be disadvantaged.
NICE advisors also looked at the information from pilots of obesity QOF indicators, but rejected them due to concerns they were merely a 'tick-box exercise'.
The two obesity indicators piloted were for producing a register of patients aged 16 and over with a record of obesity as measured by BMI or waist circumference, and for the percentage of patients on the obesity register whose notes contact a record that weight management advice or inclusion in a weight management programme had been offered at least once.
Several issues were identified by the pilot practices, including the availability of weight management programmes and public perception of the indicators at a time of NHS cuts where obesity might be seen as a self-inflicted condition'.
Pilot practices were also split on the acceptability of the indicators. 70% of practices felt both the indicators were acceptable, 25% felt both were unacceptable and 5% were ambivalent, particularly about the brief intervention.
Committee chair Dr Colin Hunter, a GP in Aberdeen, said: 'We're not ditching this as an area of importance, we just need better evidence-based indicators. We need to so something in this area, but it needs to be as evidence-based as possible.'Advisors have recommended a new set of smoking cessation indicators BOX: Smoking indicators recommended for inclusion in the OQF
• The percentage of patients aged 15 years of age and over who are recorded as current smokers who have a record of an offer of support and treatment within the previous 27 months
• The percentage of patients with coronary heart disease, peripheral arterial disease, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma schizophrenia, bipolar affective disorder or other psychoses who have a record of smoking status in the previous 15 months
• The percentage of patients with coronary heart disease, peripheral arterial disease, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma schizophrenia, bipolar affective disorder or other psychoses who smoke whose notes contain a record of an offer of support and treatment within the previous 15 months