Are the new indicators worth doing?

Readers of the Autumn issue of GP Business may have seen my calculations of the amount of money payable for meeting each of the current QOF indicators. Although there were huge variations the majority of indicators seem to have been worthwhile from a financial point of view.

In a letter to GPs in England the GPC has urged practices to review whether it will be worthwhile taking part in all of the new indicators.

Where some of these areas, such as rheumatoid arthritis, are completely new it is very difficult to predict the potential rewards.

There are a couple of areas that are easier to estimate, and the headline seems to be that these are greatly underfunded.

Three points are proposed for an annual dietary review in all patients with diabetes. Special training may be needed to allow a GP or nurse to conduct this review. In Scotland it has been confirmed that no further training is required.
The payment for this review will be around £1.55 if the practice reviews ninety percent of patients with diabetes. Even using the costings used by NICE there is only three minutes or so of nursing time available - even less if extra training is required. There is very little detail about how long that this expected to take, but this would seem quite a short time.

The estimates are similar for the annual exercise questionnaire for patients with hypertension. GPs in Scotland will be glad to know that these indicators do not apply to them, having been declared unworkable in negotiation with the Scottish government.

The General Practice Physical Activity Questionnaire (GPPAQ) is fiddly to score and will have to be applied to every patient with hypertension less than 75 years old. If we fairly conservatively assume that this would mean half of all patients on the hypertension register (it is closer to 70% in my practice) then this will work out at around a pound per patient. This is half of the payment for the much simpler depression screening questions and would not cover the cost of a mailshot or telephone survey.

There is a follow up indicator. Patients whom the GPPAQ has assessed as “less than active” should have a brief intervention. Even saying fairly generously that half of all patients are active there are only two pounds available to deliver the brief intervention. If fewer patients are “active” then this amount falls. This would have to be very brief to make this a worthwhile activity.

In one of the strange quirks which make QOF so complicated that less success in getting patients to complete the questionnaires will increase the cash available for each brief intervention.

Practices have tended to chase every possible QOF point in the past. The very high levels of point scoring - over 97% in the last few years - suggest that practices have aimed at QOF in its entirety. The lowest levels of achievement have been where evidence has been weak and hassle has been greatest - the PHQ9 indicators.

Where there is a poor business case the GPC is right that practices should consider carefully whether it is reasonable to work towards these new indicators. Picking and choosing will be a considerable change to the way that practices approach the QOF.