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ANALYSIS: Helen Lester and Martin Roland Future of quality measurement BMJ 2007; 335: 1130-1131 [Full text]

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Is the argument financial, political or both?

Hendrik J Beerstecher   (2 December 2007)

Is the argument financial, political or both? 2 December 2007
Hendrik J Beerstecher, GP principal 111 Canterbury Road, Sittingbourne, Kent, ME10 4JA Send response to journal: Re: Is the argument financial, political or both?	Dear Editor, I understood the Quality and Outcomes Framework (QOF) indicators were evidence based. Lester and Roland indicate that the UK population now receive a high level of evidence-based care. The answer to this, they seem to argue, is to drop the indicators and monitor the decline in the care the UK population is receiving. I miss the scientific argument for such action, surely if more evidenced based care is delivered through the introduction of the QOF indicators, then what is the rationale to remove these indicators? Although the authors declared a financial interest in advocating continuously changing QOF indicators, why not simply add worthwhile indicators to the framework? If their argument that QOF would become unmanageable is correct, then the decline in achievement of removed indicators is inevitable because practices will have to divert the resources to the new indicators. The authors present a logical argument against their own proposals to keep fiddling with the framework. Perhaps the discussion should concentrate on which indicators are the most valuable in terms of health gain, what level of indicators is manageable and simply leave the most valuable in place. I have another suggestion though: That new indicators and higher targets come with new or more resources, so that practices are in a position to achieve them and that the care measured by QOF can truly advance rather than deteriorate into a game of chasing goalposts on the hop. Competing interests: None declared