The Department of Health has announced that it is to go ahead with its plans to put the National Institute for Health and Clinical Evidence (NICE) in charge of the Quality and Outcomes Framework from next month.
The DH has given the rubber stamp to its proposals despite objections from GPs, local medical committees and the BMA’s GP committee in their responses to the DH’s consultation.
Concerns raised in the consultation focused on whether NICE sufficiently understood primary care to lead further development of the QOF and whether the DH agency would be less independent than the current expert panel.
The DH does, however, appear to have stepped back from any immediate plans to allow PCTs to introduce local indicators, saying that arrangements for local flexibility will need to develop carefully over time.
NICE will be in charge of reviewing existing QoF indicators and suggesting new indicators from April with the first changes due to be brought in for 2010/11.
The final decision on which, if any, existing indicators will be dropped and which new ones introduced will be left to negotiations between the BMA’s general; Practitioner Committee and NHS Employers, based on the advice produced by NICE.
Announcing the changes health minister Ben Bradshaw said the UK leads the world in providing incentives to GPs to improve the quality of patient care.
He added: “It is important that the scheme continues to provide the best health outcomes and value for money for patients. Asking NICE to lead this new process for prioritising and reviewing indicators will ensure the system is constantly updated to meet changing health needs.”
NICE has said it will set up a Primary Care Quality and Outcomes Framework Indicator Advisory Committee to review existing indicators and recommend new ones. The institute said it had already received more than 60 applications for positions to join the committee. Members are to include a range of experts and representatives from primary care including GPs, patients and carers, commissioners and practice and community nurses.
Val Moore, NICE implementation director, added: “The interest shown in the advisory committee demonstrates the high level of confidence that exists within the primary care sector for our involvement in the QoF.”
NICE said it will collate information to inform the prioritisation of new indicators based on evidence of clinical and cost-effectiveness. A new section of the NICE website will also allow interested parties to submit potential clinical and health priority topics.
The relative priority of the topics will be considered by the advisory committee which will finally carry out a consultation on the developed indicators before validating the proposals through the advisory committee and publishing its conclusions on the website.
The DH has published the results of its consultation which show that the General Practitioners Committee (GPC) of the BMA, the majority of LMCs and some GPs expressed concern about whether NICE sufficiently understood primary care to lead further development of the QOF and some respondents questioned whether NICE would provide a more independent process than the current expert panel.
However the DH said it believed NICE was the best placed organisation to manage a more transparent and objective process in developing the QoF.
Some patients groups, a number of PCTs and the Royal College of Nursing asked the DH to address what was described as high levels of exception reporting and the potential for “gaming” by GP practices. In its response the DH said it would ask NHS Employers to discuss with the GPC whether there were ways of improving current exception reporting arrangements.
On plans to introduce local QoFs the DH said that while it was clear that the majority of indicators would be relevant at a national level it still wanted the local NHS to have a greater say in how investment is used to benefit their populations. However it said decisions would need to “develop carefully over time” and said it would keep under careful review the balance between investment in the national QoF and investment in locally commissioned services.
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