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Outcomes targets come under fire from NICE



By Lilian Anekwe

Plans in the Government’s health white paper to judge GP practices and consortia by a series of hard outcome targets have been criticised by the organisation responsible for drawing them up.

NICE is set to highlight a number of serious concerns over the use of outcomes targets in its official response to the white paper, with its experts claiming they are of ‘limited use’ in assessing GP performance.

Dr Tim Stokes, clinical consultant to the NICE QOF programme and a GP in Leicester, told delegates at the RCGP conference in Harrogate last week that outcome indicators were vulnerable to ‘confounders’ outside a GP’s control.

Dr Stokes said: ‘There is only one outcomes indicator currently in the QOF, epilepsy 8 – the percentage of patients with epilepsy who’ve been seizure free for the last 12 months – and you can make up your own mind about the success of that.

‘There will be real difficulty in switching to outcomes as there are issues of confounding that will limit their usefulness.’

Dr Colin Hunter, chair of the NICE QOF indicator advisory committee, told the conference he feared ministers would push for outcomes indicators to appease the public, rather than because they were effective.

Dr Hunter, a GP in Aberdeen, said: ‘There will be a political imperative to be seen to produce outcomes. They will be sold as outcome indicators to the public but we all know they are difficult to make work.’

Professor Helen Lester, professor of primary care at the University of Manchester, runs NICE’s pilots of potential new QOF indicators.

She warned the conference that GP consortia risked being unfairly judged on aspects of care unconnected to the work GPs do.

‘For a GP a good indicator has to be attributable to the work you do. You can’t measure a GP’s or a practice’s care on long-term outcomes like mortality rates,’ she said. I would absolutely support a focus on intermediate outcomes, but not long term outcomes.’

The Department of Health said it could not comment until the consultation closed but welcomed the comments and said it would consider them carefully.

The push towards outcome measures

– Health secretary Andrew Lansley insists ramping up the number of outcome measures in primary care will provide better value for money, by rewarding GPs for reductions in cancer deaths, obesity and heavy drinking rates and improvements in patient-reported outcome measures (PROMs).

– A national NHS outcomes framework has been proposed for England to judge the commissioning ability of GP consortia: including one and five year cancer survival rates as well reductions in emergency admissions for conditions managed in primary care. NICE has also published a string of quality indicators – including COPD, CKD, and dementia – to judge GP consortia

– GP practices too will have to work to more outcome targets, with the DH asking NICE to reshape the QOF and to replace many process indicators.

Professor Helen Lester: GPs risk being judged on outcomes they can’t control Professor Helen Lester: GPs risk being judged on outcomes they can’t control