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QOF will be redrawn to focus on outcomes

By Lilian Anekwe

Exclusive: The Government will accelerate changes to the QOF to ensure that is it is refocused on health outcomes rather than process measures, despite senior academics and government advisors questioning the move.

A consultation document published earlier this week set out the Government's vision for a NHS Outcomes Framework, for use by ministers ‘as a balanced scorecard or dashboard to monitor the progress of the NHS in delivering care to patients'.

NICE is currently drafting 150 new Quality Standards that will form the basis of this framework, and a Department of Health spokesperson confirmed that they would be asking the institute to realign the QOF to mirror their work on the NHS Outcomes Framework for GPs.

‘The NHS Outcomes Framework does not replace the Quality and Outcomes Framework for GP practices, but we would expect there to be alignment between the different levels of system architecture for measuring quality and outcomes.

‘NICE is responsible for recommending QOF indicators based on NICE-accredited evidence. We will discuss with NICE and the profession how to make faster progress in refocusing the QOF onto health outcomes.'

This comes as leading GPs questioned the focus on outcomes. Professor Helen Lester, a GP in Birmingham who leads the piloting process for developing new QOF indicators under the current NICE-led process said:

‘I do personally worry that outcomes can be a blunt instrument in measuring provision and I hope subsequent white paper documentation details the need to take the impact of major issues such as deprivation into account when reporting and interpreting outcomes.'

Professor Martin Roland, professor of health services research at the University of Cambridge and an advisor to the Labour government said: ‘The recently introduced NICE standards which Mr Lansley announced as the first step towards an outcomes-focused NHS, are largely process measures.

'Outcomes are often influenced by things not under the control of the practitioner, especially in primary care, where socio-demographic factors are major predictors of outcomes such as mortality and hospital admission.'

Speaking earlier this week, NICE chief executive Andrew Dillon admitted the first of the three quality standards to be published – on stroke dementia and the prevention of venous thromboembolism – ‘are things written as process statements and they are not, as Andrew Lansley would like, based on outcomes.'

QOF will be redrawn to focus on outcomes