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The future of the Quality and Outcomes Framework in England

BMJ 2017; 359 doi: (Published 17 October 2017) Cite this as: BMJ 2017;359:j4681

Beyond QOF – a unique new national information resource?

Dear Editor,
We read with interest, the Marshall and Roland editorial on the national Quality and Outcomes Framework who suggest we ‘move on and do better’ (BMJ 2017;359:j4681).

Moving on, we might find a way to build on and develop the best of QOF in the context of a set of national data on primary care and public health process. These are instrumental national process measures for the NHS of similar essential importance to the publication of immunisation or screening rates or international measures such as the Healthcare Effectiveness Data and Information Set (HEDIS) in the USA.

These would provide:-
1. National visibility of priority clinical performance indicators for specific long term conditions at practice, CCG, GP Federation, STP, AHSN, regional level and national levels: For example, blood pressure to the recommended audit target in people with hypertension <140/90 mmHg; appropriate use of high intensity statins in people with CVD or diabetes; anticoagulation CHA2DS2-VASC score 2 or more in AF and so on….

2. A standard set of public health measures derived from GP electronic health record - to record weight/height/BMI, smoking and alcohol as well as NHS Health Check data, bowel and breast screening at practice/CCG level.

3. A set of safety indicators – eg. use of valproate in women with recorded advice for contraception and pregnancy risk; use of NSAIDs in people at high risk of CVD etc.

4. A set of diagnostic indicators to indicate extent and variability in investigations of doubtful utility – back X-rays, liver function tests, vitamin D testing and other commonly over-ordered investigations.

5. Include an age defined denominator to allow age standardisation and improved comparability - a major weakness of current QOF measures.

These would help create a framework for improving effectiveness, efficiency and safety. The need for 151 different exception codes would also be less evident were such data to be disarticulated from payment for performance.

It would be a tragedy if all the lessons learned over the last decade from high quality data entry with agreed codesets, universal data extraction and reporting and organisational comparisons were lost in the dash to jettison the more wearisome administrative components of this unique national resource.

Yours sincerely
John Robson and Kambiz Boomla

Competing interests: No competing interests

14 November 2017
John Robson
Kambiz Boomla
Centre for Primary Care and Public Health, Queen Mary University of London
58 Turner Street, London E1 2AB