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NICE supports call for QOF to reward offers of treatment rather than prescribing



EXCLUSIVE The chair of NICE has said RCGP proposals urging a change in the way QOF performance measures and guidelines are worded to give GPs greater freedom to advise patients are ’really positive’.

The RCGP’s overdiagnosis group has asked NICE to change the QOF so that GPs are rewarded as much for offering treatment as for prescribing medication, and moving away from the use of ’refused treatment’ in exception reporting codes.

NICE chair Professor David Haslam told Pulse that the suggestions were ‘tremendously helpful’, but added the body would not take forward the proposals without testing them first.

It follows the row over the proposed inclusion of an indicator for GPs to prescribe statins for any patient with a 10%10-year CV risk, which NICE finally dropped after resistance from the profession.

Currently, several indicators – such as the primary prevention statins indicator (PP001) – reward GPs for prescribing statins, rather than the offer of treatment.

But Dr Julian Treadwell, vice-chair of the RCGP’s Standing Group on Overdiagnosis, said that allowing GPs more freedom to decide when to depart from QOF indicators was important. 

Speaking at a session on NICE guidance for GPs and CCGs at this year’s annual NICE conference in Liverpool, Dr Treadwell said that a letter from the group, which has been rubberstamped by the college, suggested several changes.

He said: ‘We suggested, wouldn’t it be nice to create QOF points that were based on an offer of treatment rather than actually prescribing something and hitting a target – so you have a “statins offered” or ”statins offered with a decision aid”.’

He added that the group had also proposed that NICE change the way QOF exception reporting codes are worded, including getting rid of codes using the term ’treatment refused’.

He added: ‘It would be really good if NICE could make a powerful statement about exception reporting not being a bad thing – that it is actually good medicine a lot of the time. And we need to get rid of language that has ”refused” in them.

‘And wouldn’t it be nice if you had an exception code “not prescribed after risk-benefit consideration”. At the moment you have to wait for somebody to get a side-effect, or they have to decline it – and there is nothing that allows your judgment as a doctor to say that wouldn’t be the right thing.’

The group has also asked NICE to look at including caveats at the forefront of any published guidelines.

Professor Haslam told Pulse the letter was ‘tremendously helpful’ and that it had ‘a really positive response from us’.

He added: ’There are some details in it that we need to look at carefully, the suggestions in it are mainly very positive and supportive. That doesn’t just mean we can take the wording suggested in the letter and insert that in NICE’s documentation.

‘We have to be sure we don’t end up with unintended consequences… so we have got to test these things properly.’

Dr Alistair Blair, GP and chair of Northumbria CCG, who also spoke at the session, said: ‘[Health secretary] Jeremy Hunt is obviously keen on looking at quality metrics. If the quality metric is simply how many patients are on a statin, rather than how many patients are on a statin and how many have had an informed discussion and don’t want to be on this treatment, that’s a different measure.

’We’ve got to really aggressively make sure that we include both because otherwise informed dissent is seen as not actually having had the conversation and we penalise really good quality medicine as a result.’