GPs could be paid depending on the number of their patients who stop smoking as part of possible changes to the Quality and Outcomes Framework (QoF), according to the head of primary care commissioning for the Department of Health.
Mark Britnell, DH director general of commissioning and system management, outlined a range of possible changes to the QoF while giving evidence to the Health Select Committee enquiry into health inequalities.
Britnell told MPs that prevention should be promoted as much as possible within the QoF.
He added: “I think that I would wish over time to see, for example, smoking to be reflected more not just in recording smoking prevalence, but also in how many people quit.”
Britnell acknowledged that there was a dilemma about the extent to which individual practices could influence outcomes. However, he added: “Ultimately I would like to see some measures that actually linked what happened to patients in overcoming inequality so, if you like, proxy measures even on outcome.”
Britnell also indicated that increases to QoF thresholds are being considered as part of the Darzi review, as well as the addition of other disease areas such as osteoporosis.
The DH is also looking at how QoF indicators on areas such as smoking, cardiovascular disease and hypertension could be changed to help tackle inequalities.
He added: “We are looking at whether we can make QoF even more relevant to the people that we serve.”
He told Howard Stoate MP that he would “go back and have a think about” the suggestion of introducing more flexibility into the QoF to account for local variations in health.
The DH had planned to increase minimum thresholds for QoF to 50% and maximum thresholds in line with average achievement as part of a package of imposed changes to GPs’ contract if the profession had not accepted its offer on extended access.
The Health Select Committee also heard that the DH was working on making health information and advice a routine part of clinical practice.
Britnell flagged up the current work on information prescriptions and said work was also being carried out to make the NHS Choices website “not only more professional, but more accessible”.
Dr Fiona Adshead, Deputy Chief Medical Officer, added: “For NHS Choices we did 60 focus groups around the country on health improvement in deprived areas asking local people how we could help them and what support they wanted and they were keen on things like mobile phone messages, and the intention is to make NHS Choices multi-media.”
Details on the changes to the QoF for 2008/9, following the acceptance of the extended access package by GPs, are expected to be released in the next few days.