NICE New Indicators Consultation

NICE has a current consultation about possible new QOF indicators. It is open until the 11th of April (a week after Easter) and is certainly worth a look.

I won't go through the whole thing here, if you are interested you can read my submission. I will admit I am a little disappointed in the general scope of the indicators. Some of the current indicators are joined together and some are split apart. There is little feeling of an overall strategy or direction and even less of how indicators fit into the whole QOF. There is not really enough information to give a proper response. They are knee to know about potential unintended consequences but these tend to appear at the business rule level and there are not even draft versions of these. The document reads more as a list of intentions than indicators ready to be used. They don't even included suggestions of point scores which should be part of the economic evaluations.

I suppose this may get sorted at the negotiation level but we probably won't know that for another nine months. We will also find out how much the DH and GPC think of the QOF Advisory committee's work.

Prevalence Predictions

I am grateful for an email pointing me to some work done to try to predict the prevalence of QOF related diseases. The prediction is based on the age, sex, ethnicity, deprivation and smoking status of a practice's population. Readers with long memories may remember something similar being done by the North East Health Observatory a few years ago. This new work, however, covers more disease areas and is rather easier to use as the predictions are now featured on NHS Comparators (that link only works on NHS computers, sorry)

The methodology is interesting as the "expected" prevalence is based on various household surveys rather than GP data. The national prevalences are all rather lower than the "expected" prevalences except for cancer. The high relative prevalence of cancer in the QOF data is likely due to the predictions being based on one year and QOF registers being based on several years.

It is possible to argue with the methods of determining prevalence. It is not entirely clear that it is desirable that medically recorded prevalence should be the same as some of these surveys. Data about pratice populations is generally limited to age and sex and so various assumptions and approximations have been used in the model with data from other sources. Whilst there is some validity in these objections they do not justify writing off this work. For the first time at an accessible national level there is an attempt to produce corrected prevalence figures for practices. Comparison of one practice with another is still not simple but it is a little simpler. It is only thing that has made me log on to NHS Comparators recently.