Process measures face QoF chop

Four potential new indicators for inclusion in next year’s Quality and Outcomes Framework together with five indicators that could be removed from the QoF have been published.

The National Institute for Health and Clinical Excellence (NICE) has published its first menu of suggested inclusions and deletions from the QOF since it became responsible for managing the process of developing indicators and reviewing the existing indicators in April 2009. Its recommendations will be the subject of negotiation by the BMA’s GP committee and NHS Employers.

The five indicators up for ‘retirement’ cover incentives to record measurement of blood pressure in patients with stroke, heart disease and diabetes and similarly recording of blood sugar levels and cholesterol in patients with diabetes.

The suggestions for deletion cover ‘process’ activities rather than ‘outcome’ based work as expected. NICE’s QoF advisory committee said it had selected indicators where it believed there was a low risk of the activities being reduced because there was already a matched indicator covering outcome. One example is the level of blood pressure control achieved by practices for patients who have had a stroke.

However the BMA’s General Practitioner Committee said it was concerned that getting rid of such indicators could risk undermining patient care.

Dr Richard Vautrey, GPC deputy chairman, told GP newspaper: “There is very good evidence that process indicators are as important as outcome indicators, if not more so. If you invest in a process, you will achieve an outcome. Ignoring the value of process indicators risks undermining the foundations of QOF.”

The first of the new indicators to be published by NICE proposes setting two new targets for blood pressure control in patients with diabetes, one of 150/90mmHg and another of 140/80mmHg.

The other two new proposed indicators cover new indicators for patients with learning disabilities and patients with epilepsy. The epilepsy indicator proposes a reward for offering information on contraception, conception and pregnancy to women with epilepsy and the learning disabilities indicator covers measuring and recording thyroid-stimulating hormone in patients with learning disabilities.