The Government has deferred the introduction of two new indicators for referral to cardiac and pulmonary rehabilitation services until 2014/15, it has announced.
The DH has said because relevant services to support new NICE-recommended indicators on referring to cardiac and pulmonary rehabilitation services are currently only available to approximately 10% of practices, it will introduce new exception codes where a secondary service is not available.
The consultation response said: ‘In the case of pulmonary and cardiac rehabilitation, we recognise that availability of services is currently low nationally…We therefore propose to defer introduction of the indicators until 2014/15 to give practices time to work with CCGs to ensure these NICE recommended services are available to patients by that time, either in their locality or within reasonable distance.’
It added: ‘Because it may not be possible at least in the short term to identify a suitable service that all patients could attend, we will request new exception codes to identify where a secondary service is not available’
The number of QOF points awarded for the new blood pressure control for patients aged 79 or under with hypertension indicator will be increased, using the ten QOF points released from the indicators on pulmonary and cardiac rehabilitation, the DH announced.
It will also introduce phasing in thresholds for two of the indicators incentivising GPs to give advice on physical activity over two years, as well as increasing QOF points for these and the new indicator on blood pressure control, to recognise the initial impact on practice workload.
Other changes, such as removing the funding of the organisational domain of the QOF, raising thresholds for existing indicators in line with the 75th centile of achievement and the creation of a new ringfenced public health QOF domain worth 150 QOF points will be introduced as planned.
It has also confirmed all the NICE recommendations for the changes to QOF, the retention of the quality and productivity indicators for another year and the removal of the current overlap of QOF years by reducing the time period for most indicators from 15 months to 12 months.
The GPC have warned that GPs will struggle with the extra workload and lack of extra funding that these changes will incur, while a top NICE-adviser recently admitted that the hike in thresholds could disincentivise low achieving practices.
The following indicators have been deferred until 2014/15:
The percentage of patients with heart failure diagnosed within the preceding 15 months with a subsequent record of an offer of referral for an exercise-based rehabilitation programme within the preceding 15 months.
The percentage of patients with heart failure diagnosed within the preceding 15 months with a subsequent record of an offer or referral for an exercise-based rehabilitation programme within the preceding 15 months
The DH have introduced phasing in the thresholds and increasing the points of the following indicators:
The percentage of patients with hypertension aged 16 or over and under the age of 75 in whom there is an annual assessment of physical activity, using GPPAQ, in the preceding 12 months
The percentage of patients with hypertension aged 16 or over and under the age of 75 who score ‘less than active’ on GPPAQ in the preceding 12 months, who also have a record of a brief intervention in the preceding 12 months.
The DH have increased points for the following indicator:
The percentage of patients aged 79 and under with hypertension in whom the last blood pressure reading (measured in the preceding 9 months) is 140/90 mmHg or less