01 August 2014

Annual diabetes checks among indicators proposed for latest NICE QOF menu

A series of annual checks to monitor and improve the health of people with diabetes are among measures proposed by NICE for its latest Quality and Outcomes Framework (QOF) indicator menu.

The QOF is a voluntary incentive scheme for GP practices in the UK, rewarding them for how well they care for their patients, and helping them target resources for where they are most needed. It consists of groups of indicators against which practices score points according to their level of achievement.

NHS England, and health administrations from Northern Ireland, Scotland and Wales, can use NICE’s QOF menu to determine which indicators are used within the QOF within their own countries.

For the latest QOF menu, NICE proposes a bundled indicator of eight checks for people with diabetes.

Around 3.2 million people are diagnosed with diabetes in the UK, with numbers of people diagnosed with the condition increasing sharply in the last year.

NICE recommends that people with diabetes should receive annual health checks to monitor and manage their condition, as well as reduce the risk of complications associated with the condition, such as heart disease and amputations.

However, NHS figures suggest less than 10 per cent of people are being offered the full series of tests recommended by NICE in some areas of England.

To address this, the latest QOF menu proposed by NICE includes an indicator that measures the percentage of people with diabetes who have the following care processes performed in the preceding 12 months:

  • BMI measurement
  • BP measurement
  • HbA1c measurement
  • Cholesterol measurement
  • Record of smoking status
  • Foot examination
  • Albumin: creatinine ratio
  • Serum creatinine measurement

The latest NICE QOF menu also includes three new indicators to support high quality care for people with newly diagnosed hypertension.

NICE says that it is important to assess target organ damage, as this can alert GPs to possible secondary causes of hypertension, some of which can be potentially life-threatening. The indicators for target organ damage measure the ratio of urinary albumin to creatinine, testing for haematuria, and a record of ECG.

Elsewhere, NICE has updated the atrial fibrillation QOF indicators to reflect updated guidance on the condition.

Latest guidance on the management of atrial fibrillation makes a strong recommendation that aspirin should not be offered to people with atrial fibrillation solely for stroke prevention. It also recommends the use of a new tool to assess the risk of stroke.

To reflect this, two new atrial fibrillation indicators have been added to the NICE QOF menu and one has been taken out.

All indicators are based on the most up-to-date evidence and have been piloted across a range of practices with the support of the University of Birmingham and the York Health Economics Consortium, and the Health and Social Care Information Centre.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “These proposed new indicators for family doctors will help set high standards of care and improved results for patients. 

“All of the proposed new indicators are based on the best evidence and have been developed in consultation with professional groups, patients and community and voluntary organisations. They have also been tested across general practice to make sure they work.

“The independent QOF Advisory Committee has carefully considered the indicators before recommending them for inclusion in this final menu, and we are confident they will improve patients’ health.”

Dr Colin Hunter, Chair of the QOF Advisory Committee, added: “The independent QOF Committee has thoroughly deliberated on all of the evidence, consultation responses and feedback from piloting, so we believe that the ten proposed indicators that we’ve put forward on today’s menu will improve the care that GPs provide for their patients.

“Our independent Committee is made up of healthcare professionals and lay members with a wide range of expertise. This depth of experience is invaluable in helping us reach robust clinical decisions on indicators that are practical for GPs to undertake, and that we expect will be essential for improving the quality of patient care.”

Also published today are new indicators for the Clinical Commissioning Group Outcomes Indicator Set (CCG OIS), to support better quality healthcare commissioned by the NHS.

Additions to the NICE CCG OIS menu include an indicator to support high quality rehabilitation for people admitted to hospital with coronary heart disease; a number of indicators to support antenatal and maternity care; and a process-based indicator to support high quality care for people with a hip fracture.