Lord Darzi’s NHS review outlines plans to overhaul the Quality and Outcomes Framework (QoF) to place a greater emphasis on health promotion activity.
Higher Quality Care for All: The NHS Next Stage Review states that the number of organisational and “process” indicators in the QoF will be reduced as part of plans to give GPs greater incentives to deliver health promotion activities.
In his introductory letter about the review Lord Darzi said the government would work with “world-leading professionals and patient groups” to improve the Quality and Outcomes Framework. More local flexibility to select indicators for the framework is also likely to be introduced.
The “process” indicators reward practices for carrying out tasks such as blood pressure checks. It has been argued that there should be much greater emphasis on the indicators that reward practices for the outcomes achieved, such as the percentage of patients with well-controlled blood pressure.
Lord Darzi’s document states that the DH will introduce a new strategy for developing the QoF, this will include “an independent and transparent process” for developing and reviewing indicators.
Higher Quality Care for All adds that current incentives focus largely on the effective management of long term conditions rather than seeking to prevent those conditions in the first place.
The report states that the framework will be reviewed “to provide better incentives for maintaining good health as well as good care.”
The DH intends to discuss its plans for changing the QoF with NICE, together with stakeholders including patient groups and professional bodies.
It adds: “We will discuss how to reduce the number of organisational or process indicators and refocus resources on new indicators of prevention and clinical effectiveness.”
The report says the DH will also explore giving greater flexibility to PCTs to select quality indicators from a national menu to reflect local health improvement priorities.
Lord Darzi also plans to see the concept of a quality framework applied to the whole of the NHS. The report says that the DH is working with clinicians to identify comparable measures that will be brought together into an integrated national set of indicators.
The first new set of indicators is likely to apply to acute care and will be published by December 2008 but the document says the DH will also pilot a quality framework for community services.
In addition ‘clinical dashboards’ will present nationally and locally developed measures in a graphical format as a tool to drive quality improvement to patients in waiting rooms, clinics and online.
The report says the kind of ‘dashboards’ already in use include a Bolton GP practice which displays information on the number of patients attending A&E and out-of-hours services and an east London A&E department which presents information, updated every 15 minutes, about how soon patients are seen, assessed and get results from tests and about patient satisfaction.
Other aspects of the Darzi report cover the possibility of introducing a new three digit telephone number to access urgent care, the development of practice based commissioning, the introduction of integrated health and social care organisations and greater use of telecare and telehealth.
The report says the DH is to learn from local work on the use a new three digit telephone number and that it will examine the costs and benefits of an urgent care number. Further details will be set out later in the year.
Lord Darzi also pledges to reinvigorate practice-based commissioning (PBC) and ensure PCTs are “held fully to account” for the quality of their support from PBC including the quality and timeliness of data given to PBC groups.
The document also outlines plans to pilot new integrated care organisations, bringing together health and social care professionals from community services, hospitals, local authorities and others.
The review adds: “In future the NHS will not be confined to hospitals, health centres or GP surgeries but will be available online and in people’s homes, whilst the most specialist care will be concentrated to allow excellence to flourish.”
The report also predicts that there will be greater use of assistive technology and remote monitoring and highlights the Whole System Demonstrator project in Cornwall where 1,000 people are having biometric equipment installed in their homes to enable them to monitor their own blood pressure, blood sugar and blood oxygen levels.
The report adds: “This is better for patients and their carers, delivers improved outcomes and is a very efficient way of using NHS resources.”
Detailed plans for primary care are due to be published on Thursday when the government will release its document NHS Next Stage Review: Our Vision for Primary and Community Care. Darzi said the strategy would focus on making services personal and responsive to all, promoting healthy lives and improving the quality of care provided.