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by Dr Gavin Jamie
2 August 2013

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Blog: NICE’s QOF proposals are ‘mostly dull’

Only one change proposed by NICE for the new QOF framework upgrades their suggestions from “dull” to “mostly dull” according to QOF expert Gavin Jamie

After last year’s imposition the new indicators proposed by NICE for the Quality and Outcomes Framework have been eagerly awaited. To summarise them in a word, they are dull; in two words, mostly dull.

Don’t get me wrong, from the point of view of practices dull is good. It is certainly not the purpose of NICE to quicken the heart and catch the breath. Dull is very much what was wanted.

Of the ten new indicators three are simply extending the blood pressure threshold of 140/90 for the under 80s to the CHD, peripheral arterial disease and stroke areas. Another two are for recording carers of people with dementia having that diagnosis made in a specialist clinic. These are part of the dementia DES this year so there is again little change.

There are a few other tweaks and an indicator about giving preconceptual advice to patients with diabetes. That will have to be repeated every year, from year two onwards that might be quite brief.

Exercise based courses for patients with heart failure and COPD, not implemented this year in England remain on the register. It will be up to the negotiators whether they are any more feasible next year. 

The indicator which adds the “mostly” to my “dull” rating is the indicator requiring that every new diagnosis of hypertension after the first of April 2014 should be made after either an ambulatory blood pressure measurement over 24 hours or twice daily home blood pressure measurements over three days. NICE believes that over three quarters of practices already have an ABPM machine and that all others have access to services that offer patients the ability to have their blood pressure monitored while they are moving around. Around 0.8% of registered patients are expected to need to be tested.

That is a lot of patients, some considerable capital outlay for practices and quite a lot of organisation – never mind the hygiene issues! If this is thought to be feasible it will take a significant allocation of points to make it viable for practices.