What would David Cameron do?

Not the first question I would ask myself in any difficult situation but certainly has some relevance to QOF. Last week the Conservatives announced their new health policies. The one that interests us is "Outcomes not Targets".

Now it is hard to argue with that slogan. Outcomes are what matters. When it comes to drugs we are most interested in whether lives are saved or improved rather than exactly how much the blood pressure is changed or whatever. There is also no denying that most health targets are based more on process than outcome. In the QOF we have lots of targets about how often people have their blood pressure taken or an inhaler check and only one or two about any outcomes such as cholesterol or blood pressure readings.

So what to the Conservatives plan to do about it? Well all that is on their website is a show as a PDF - so there is not a lot of detail - but they do talk about putting the EQ-5D into the framework. If you are not familiar with the tool then follow that link for an example of the form. It is pretty short 5 question survey and at least appears to be easy to administer.

What is not clear is what happens next. For all the literature that I can find this is very much a research tool. There is not a lot of evidence for its use in general practice and what there is measures the patient rather than the practice. It would also be very difficult to separate out the effects of primary care, secondary care and social services.

It is probably a bit much to expect the fine details of implementation from a mid term opposition policy review. The answers to some questions would be nice though.

How is this translated into a points score and then (the final outcome) into cash? The score varies quite dramatically with age, sex and socioeconomic group. Paying for high health status would simply favour practices with younger and more affluent patients. Paying for health status improvements would reward practices starting from a low baseline rather than those who have worked hard in the past. Practices could also be 'rewarded' for a new housing estate or 'punished' for a factory closing. I will write and ask.

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