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NICE to explore multimorbidity QOF indicators on mental health and frail elderly care

NICE will look at bringing back a comorbidity indicator on mental health into the QOF as well as developing indicators aimed at addressing multimorbidity in the elderly, QOF advisors have decided.

The NICE QOF advisory board members discussed potential indicators on multimorbidity – at the request of NHS England – at their committee meeting this week, and came up with four broad areas for development, including: comorbidity of mental and physical health problems; nursing home care of complex elderly patients; care of frail housebound patients and polypharmacy review in the elderly.

Advisors did not discuss any specific new indicators although they said care of mental health problems in people with long-term conditions such as heart disease and diabetes should be revisited, after screening questionnaires on depression in coronary heart disease and diabetes were dropped in previous rounds of contract negotiations.

Committee members also repeated their call for the reintroduction of indicators on vascular risk factors in people with severe mental illness, which were dropped as part of negotiations to radically reduce the size of QOF in this year’s contract.

The team agreed to explore potential new indicators aimed at addressing the needs of complex nursing home patients, as well as frail elderly patients who are housebound. And they also determined to do more work on a potential indicator to address polypharmacy, despite a potential indicator on review of patients on ten or more medications failing to get past the piloting stage this year.

Other areas pinpointed for development of new indicators were obesity and immunisations – in light of discussions with Public Health England.

However, advisors were sceptical about meeting another request from NHS England to develop ‘more outcomes-focused indicators’.

The Committee agreed that any purely outcomes-based indicators would be too difficult to measure at practice level, because of the relatively small number of events tied to indvidual practice registers and the difficulty taking account of agencies and factors outside GPs’ direct control.

Instead they proposed defining more clearly in the QOF how process measures are closely linked to outcomes.