Professor Helen Lester, clinical lead in QOF development, talks to Summons about what goes into a clinical indicator
Where ualit meets outcomes
T
HE QOF or Quality and Outcomes Framework has been much in the news lately with the recent launch of a 12-week consultation on proposed
changes to the GMS contract – there now being the risk of a Government “imposition” of QOF changes should negotiations with the GPC in England fail. QOF is a system for the performance management and payment of general practitioners in which quality and outcomes are incentivised. Te clinical indicators against which performance is measured are developed by a group of external contractors led by Helen Lester, professor of primary care at the University of Birmingham. She is also a practising GP.
Eight years down the line from the 2004 contract do you think that QOF has achieved its overarching goal? Is the UK a healthier nation? Yes. I do think some of the improvements in health we’ve seen in the last few years in people with long- term conditions are associated with QOF. Part of the problem of answering that question with absolute conviction though is that back in 2003/4 when QOF was being dreamt up and negotiated I am not certain that anybody formally wrote down what the purpose of it was. And I think some of the problems that have
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come to light since then are related to the absence of that very simple task. If QOF was there as a GP pay rise then it achieved its goal in the short term but not in the long term because I think there have been elements of claw back – really since 2005 once the Government realised that GPs were going to receive a significant increase in their income. If the goal was to improve patient care then, yes, it did indeed achieve that but at quite a slow pace. I think we could have done it much more quickly had that been the stated clear primary aim.
What is your role in the QOF? I lead the external contractor group and have done so since 2005. What we do is devise the clinical indicators – not the organisational ones. We are a collaboration of people working in the University of Birmingham and also the University of York. Te cost effectiveness of the indicators is developed by YHEC [York Health Economics Consortium] and the clinical elements of the indicators – the wording, the feasibility, the face validity, the reliability of them, looking for unintended consequences and piloting them – that’s my group based in Birmingham. Since NICE took over the development of QOF in 2009 we have produced 75 indicators.
SUMMONS
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