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New QOF proposals focus on mental health

NICE proposes better support for mental health patients

Adrian O'Dowd

Wednesday, 05 August 2015

GPs could be expected to improve care for their patients with mental health needs under new proposals from the National Institute for Health and Care Excellence (NICE).

NICE has published its proposals for indicators that will be the subject of imminent negotiations for the 2016-17 QOF between it, the BMA, NHS England and NHS Employers. Separate but similar negotiation processes will be carried out within Scotland, Wales and Northern Ireland.

NICE’s proposals include new indicators as well as updates to existing ones.

New indicators have been suggested that will ask GP practices to identify:

  • people with severe mental illness that have a high risk of cardiovascular disease
  • patients with a new diagnosis of depression and/or anxiety disorder to ensure they are offered referral for psychological treatment within three months of the date of diagnosis
  • people with a body mass index (BMI) recording in the past 12 months who have heart disease, stroke, diabetes, hypertension, peripheral arterial disease, heart failure, chronic obstructive pulmonary disease (COPD), asthma and/or rheumatoid arthritis
  • the percentage of patients with heart disease, stroke, diabetes and/or COPD who have had influenza immunisation.

NICE is also proposing changes to existing indicators and is undertaking a piece of work due to publish later this month that will suggest a number of indicators be ‘reassessed’, meaning they could be changed, removed or replaced.

Earlier proposals from NICE to recommend an indicator that would incentivise GPs to prescribe statins at a 10% primary prevention risk threshold appear to have been put on hold for now.

In its place, NICE is recommending slight modifications to the current indicator that rewards practices for treating patients with a 20% risk threshold, thus widening it to more patients.

However, NICE said piloting and testing would be undertaken to inform further potential indicators covering various elements including:

  • lifestyle modification
  • informed decision making
  • statins prescribing for people that have a 10% or greater 10-year cardiovascular risk
  • the establishment of a register that would allow the identification of people with a 10% or greater risk 10-year cardiovascular risk.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE said: “These new indicators for general practice will help set high standards of care and improved outcomes for patients.

“All of the indicators are based on the best evidence and have been developed in consultation with professional groups, patients and community and voluntary organisations.

“They have also been tested across general practice to make sure they work. The indicator advisory committee has carefully considered the indicators before recommending them for inclusion in this final menu, and we are confident they will improve patients’ health.”

Professor Danny Keenan, NICE’s indicator advisory committee chair, said: “All the indicators have important evidence backing them up. They have been tested out and have received favourable responses from GPs.

“What is really exciting is that the new indicators cover a wide range of conditions and have moved into the more difficult to manage areas such as mental illness and the physical ill health that goes along with severe mental illness.”

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