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NICE advisors refuse to back ‘next generation’ of QOF indicators

NICE advisors have rowed back from recommending ‘next generation’ QOF indicators that incentivise practices to achieve clinical outcomes in fixed groups of patients, arguing that they were ‘ferociously complicated’ and would be difficult to implement in practice.

The Primary Care QOF Indicator Advisory Committee heard the new type of clinical QOF indicator – seeking to reward changes in GP behaviour – currently being piloted by NICE – have proved complex and contradictory.

The so-called ‘tightly linked markers’ are aimed at encouraging GPs to improve the outcomes of patients, such as reviewing cholesterol levels in diabetic patients and initiating or intensifying statin therapy.

In a scheme piloted in 66 practices, GPs were expected to identify patients with type 2 diabetes who had a cholesterol over 4 mmol/L, and to start them on a statin if they weren’t already on one. For patients already taking a statin but had a cholesterol over 4 mmol/L, GPs were expected to increase the dose or change to a different drug.

However, results from the pilot found the indicator resulted in only minimal changes in outcomes and was too complex and difficult to implement for GPs.

The pilot showed only a very small increase in the proportion of patients with poorly controlled cholesterol with statin therapy initiated or modified during the 12-month pilot had a very small increase – from 3.1% to 3.9%.

Reviewing the findings yesterday, GP members of NICE Primary Care QOF Indicator Advisory Committee said the new proposed new indicators were ‘ferociously complicated’ and would be difficult to implement in practice.

They questioned the rationale for introducing an incentive for intensifying statin therapy in patients with diabetes, when evidence suggested that all patients would benefit from statins regardless of
lipid levels.

They also suggested that the indicators would promote ‘statin churn’ and that they would penalise GPs who measured cholesterol more frequently if these showed patients weren’t in the target range.

A NICE adviser said the new indicators had been received positively by most of the pilot practices , and they only required 10 minutes of explanation.  They were keen to see the first TLM introduced as a ‘template’ for more indicators that linked clinical processes with outcomes.

However, the committee concluded that there were serious issues with TLMs that needed to be addressed before they could be considered for introduction.