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Revealed: NICE’s blueprint to shrink the QOF

NICE has called for a return to 15-monthly QOF reviews and the removal of controversial indicators on depression screening and checking physical activity in patients with hypertension, in a blueprint on how to shrink the QOF commissioned by NHS England.

In the first indication of what NHS bosses may be prepared to remove from the framework to free up GPs for other activities, NICE has recommended the number of follow-up invitations are reduced, some indicators are shifted to other areas and some indicators with ‘little impact’ are deleted completely from the QOF.

The recommendations - made at a special meeting of the NICE QOF Advisory Committee - came after a review of the underpinning evidence, known problems, workload and achievement on the various indicators requested by NHS England.

NICE QOF advisors said there was ‘much to be gained and little to be lost’ by reverting to the 15-month timeframe for all annual indicators, reduced to 12 months in April this year. They said the change had increased workload without any change in the quality of care for patients – and admitted it put GPs under even more pressure at the peak winter workload months of February and March.

They agreed the DEP001 depression indicator, requiring a biopsychosocial assessment when diagnosing depression, ‘adds to workload as it interferes in the natural process of these often long and complex consultations’ and that it ‘could be removed with little impact on the quality of care’.

The committee also conceded that dropping the unpopular HYP004 and HYP005 indicators, requiring GPs to do an annual screen of patients’ physical activity using the GPPAQ questionnaire and give advice on exercise to do those with low scores, would ‘have minimal impact on patients’ health’.

As revealed by Pulse, NHS England announced back in May it would be looking at ways to scale back the size of QOF and look at other ‘more creative’ ways to incentivise good care, and health secretary Jeremy Hunt recently pledged to ‘dramatically’ simplify the QOF in next year’s contract.

The GPC said recently that after a survey it would be lobbying for removal of the hypertension physical activity screening indicator in particular.

Other suggestions from the NICE advisors include reducing the number of follow-up invitations to QOF reviews and moving some indicators into other frameworks – for example, child health surveillance could be incentivised more effectively through CCG outcomes indicators.

It was also suggested that introducing broader clinical areas to incorporate indicators in related disease areas could simplify the QOF, although ‘this would not impact on current workload’.

In addition the board suggested the option of ‘recycling’ clinical areas, whereby areas are removed and re-introduced periodically.

The committee was not able to make any recommendations on the balance of points for QOF indicators or the controversial quality and productivity indicators, as they are outside its remit.

Professor Martin Roland, professor of health sciences research at the University of Cambridge and a part-time GP in Cambridge who helped develop the QOF and has repeatedly called for the amount of work involved to be reduced, said of the developments: ‘Fifteen month reviews always made sense. If the target is 12 months, too many people end if having to be reviewed in 10 months. There was never a good reason for changing this.

He added: ‘It makes sense to drop DEP001. While the concept of a biopsychosocial assessment is a sound one, it’s simply not amenable to putting into a box to tick. This is a good example of a very important aspect of care that simply isn’t amenable to QOF type indicators.

‘This emphasises that QOF is never going to cover some very major and important aspects of care, just because they can’t readily be measured. This is one of the reasons why I think QOF should make up a smaller percentage of GPs’ income – something around 10% would be better than the current 25%.’