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GPs unlikely to be measured on ‘true outcomes’ by commissioning framework

By Lilian Anekwe

Exclusive: Judging GPs on their success as commissioners using real outcomes such as cancer survival is unlikely to be feasible, the NICE adviser charged with developing the measures has admitted.

Dr Fergus Macbeth, director of the NICE centre for clinical practice, said the Commissioning Outcomes Framework might have to include many process or intermediate indicators instead.

The institute is developing quality standards for treatment across disease areas for the framework, which is set to be used to reward GPs for their performance in meeting commissioning targets.

Health secretary Andrew Lansley had controversially suggested GPs would be judged on their performance in areas such as improving one-year cancer survival or cutting premature deaths from heart and lung disease.

But Dr Macbeth conceded that while moving away from process-based measurement was the aspiration, it might not be possible to measure performance purely on outcomes: 'The plan is to develop pilot indicators based on existing quality standards, draft indicators and work with the NHS Information Centre to see if they can be measured in real life. It's quite possible that some of these things may not be outcomes, they may be process or interim measures.'

Dr Macbeth said the issue would be tackled during the 'nitty gritty' of development: 'In an ideal world we would like them to be true outcomes measures, but we are aware of the difficulties. There's got to be some pragmatism about this. It's likely we will end up not being able to use true outcomes.'

A Department of Health spokesman said: 'The NHS Outcomes Framework sets out national outcomes goals. The NHS Commissioning Board will translate these into outcomes and indicators that are meaningful at a local level.'

Andrew Lansley had controversially suggested GPs would be judged on their performance in areas such as cutting premature deaths from lung disease

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