A new suite of indicators for asthma and COPD has been published by NICE which includes several potential new indicators for the Quality and Outcomes Framework (QOF) – a voluntary annual reward and incentive for all GP surgeries in England.
A review of the current indicators for asthma, COPD and heart failure was agreed following NHS England’s 2018 review of the QOF. The suite also includes a range of indicators to support people in reducing their alcohol consumption and an indicator that can be used to measure multimorbidity.
Four of the new indicators will help improve diagnosis and ongoing care for people with asthma. A misdiagnosis of asthma can have life-long implications and result in unnecessary treatment.
The new asthma indicators encourage general practice staff to undertake an annual review that includes an assessment of asthma control using a validated asthma control questionnaire (including assessment of short-acting beta agonist use), a recording of the number of exacerbations and a written personalised action plan.
Assessing the use of short-acting beta agonists and recording exacerbations can help identify people with asthma who are at increased risk of poor outcomes. People with asthma can use information and advice from these reviews to inform how they self-manage their condition, maximising their future health.
Likewise, the new COPD indicators recognise the importance of using objective testing to confirm a diagnosis of COPD. The new indicators link diagnosis and objective testing to entry onto the QOF COPD register. This should contribute towards a reduction in both misdiagnosis and the risk of overtreatment in people with COPD.
Additionally, a new potential QOF indicator for people with heart failure reduces the timeframe in which an echocardiogram or specialist assessment should take place. Ensuring people with heart failure receive the right diagnosis and receive timely treatment will improve quality of life and help reduce premature mortality.
NICE’s menu of QOF indicators has been developed to inform negotiations for the 2020/21 QOF in England. QOF forms part of the General Medical Services (GMS) contract, and as such proposed changes to QOF are subject to negotiations between NHS England and the BMA’s General Practitioners Committee.
NICE has also developed indicators for use outside of the national QOF to improve outcomes for people with familial hypercholesterolaemia (FH) and support implementation of the NICE quality standard on HIV testing (QS157). These indicators can be used to support quality improvement and measurement at a local level.
Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “There is currently no gold standard test for asthma which makes diagnosing a particularly difficult task for clinicians. It’s important that GPs take the appropriate steps to avoid misdiagnosing the condition which can lead to overtreatment. These new indicators should increase the likelihood of improved outcomes and support the personalisation of care for people with asthma.”
NICE indicators measure outcomes that reflect the quality of care, or processes linked to improved outcomes. NICE reviews and maintains its menu of indicators, ensuring they are in line with the latest guidance. New and updated indicator are added every year, in August.