Dr Bill Beeby's analysis piece on the proposed revamp of diabetes QOF indicators makes one suspect it's the NICE standards, not the National Diabetes Audit (NDA), that he objects to (Flawed audit is no basis for altering GP pay).
QOF is a payment mechanism – the NDA is a clinical audit that assesses compliance with NICE guidance. So it is hardly surprising that the NDA and QOF headline results look so different. At 95% of available points for diabetes, QOF indicators mean the negotiated ‘achievable performance' was attained in 95% of cases – by contrast, the NDA's bundle completion is based on all NICE-specified checks being carried out in every patient.
The bundle completion figure of 54.3% doesn't mean that 45.7% of patients are receiving unsatisfactory care. Indeed, the NDA shows that when individual tests are considered, each is completed in at least 80% of patients.
The NDA tries to keep in synch with QOF, but its code set is slightly smaller due to strict alignment with NICE standards. Far from being flawed, the NDA is the reliable method for ascertaining overall compliance with NICE recommendations. Hopefully it will continue to support and chart continuing improvement.
From Dr Roger Gadsby, GP clinical lead for the National Diabetes Audit
