NICE’s role in further developing the Quality and Outcomes Framework is in question

Guthrie and Morales highlight that radical change is coming to the clinical and public health indicator set of the UK’s Quality and Outcomes Framework (QOF) in 2014-15.1 2 3 They, however, only partially explore the roles of the National Institute for Health and Care Excellence (NICE) and NHS England in retiring indicators from QOF, and the implications for patient care.

Many of the changes seem inconsistent—for example, the lipid target indicator is retained for people with diabetes but not for people with established cardiovascular disease. Unlike the role of NICE in the QOF process, the rationale for NHS England’s decisions is not in the public domain, and the negotiators have gone further than the advice they received from NICE. Most of the indicators that have been dropped (16/30; 53%) were recently developed using the NICE indicator development process (2011-12 QOF or later). It is worrying that recently developed indicators, particularly those introduced only a year ago, are now being retired. These indicators are likely to represent quality improvement because they are less likely to have become embedded into routine practice.

Furthermore, the NICE advisory committee thought that most of the retired indicators (16/30; 53%) were important to retain. The fact that the negotiators chose not to accept NICE’s advice in full also raises questions about the impact of NICE in further developing the QOF, and the resulting loss of public accountability in the decision making process.