The Department of Health (DH) has published a consultation document setting out proposals to reform the quality and outcomes framework (QOF), a programme of incentives offered annually to GP surgeries in the UK. Rewards are given for, among other things, how well they manage some of the most common chronic diseases and how well they improve the health of the populations they serve.
If the proposals are accepted, NICE will oversee a new independent, transparent and objective process for reviewing and developing these indicators.
Introduced in 2004 as part of the general medical services contract, the QOF contains five main groups of indicators, against which practices score points - and financial rewards - according to how well they perform.
The indicators cover everything from clinical treatment (such as the treatment of coronary heart disease and hypertension) to the prevention of ill health and the promotion of good health (such as cervical screening and contraceptive services).
Under the new proposals, NICE would produce an annual ‘menu' of evidence-based, cost-effective indicators. Currently, QOF indicators do not take into account the cost-effectiveness of a service or approach. We would also recommend whether or not a particular indicator should continue to be part of the QOF award scheme. For example, if the activity being measured has become part of standard clinical practice then there should be no further need to provide such an incentive.
The idea is that NICE would establish a primary care consideration panel. This would be chaired by an independent primary care medical expert and include a range of other experts and representatives, for example, GPs, nurses, social care professionals, patients and carers.
Interested parties would submit potential clinical and public health topics for consideration to the NICE website. The panel would then prioritise these, based on evidence of clinical and cost effectiveness. They would be put out for consultation, along with supporting cost effectiveness evidence and a recommendation on when the indicator should be reviewed.
The panel's final conclusions, based on the consultation, would be published on our website.
The decision about which indicators should be included in the QOF - and what type of reward each one should carry - would still be negotiated by NHS Employers (on behalf of the DH) with the British Medical Association. Primary care trusts would agree with GP practices, in consultation with local medical committees and other interested parties, which ones from the national list would be used locally.
The new proposals reflect the need, highlighted in the recent ‘NHS next stage (Darzi) review', for a more independent and transparent process for reviewing and developing QOF indicators. They also reflect the need to give PCTs the opportunity to select indicators that reflect local health improvement priorities.
‘NICE will be at the heart of a process that ensures QOF indicators address topics of importance to patients, professionals and the public, and help professionals make best use of NHS resources,' said Clinical and Public Health Director Professor Peter Littlejohns.
‘By overseeing the development and review of these performance indicators for GPs, we can ensure the principles behind our recommendations are reflected in the QOF. This will encourage implementation of NICE guidance across the country so that, irrespective of where people live, they can expect the same high standards of healthcare.
‘The overall aim is to help healthcare professionals deliver the best possible care in the world.'
This page was last updated: 12 July 2010