Strong protests have greeted the National Institute for Health and Clinical Excellence (NICE)’s proposal that all three indicator measures for depression should be dropped from the 2012-13 Quality and Outcomes Framework (QOF) menu for primary care, because there is not enough evidence to support them.
There have been serious concerns over the quality of supporting evidence for the three indicators. However, organisations representing mental health providers and patients warn that removing “at a stroke” the financial incentive for family doctors to manage the care of patients with depression and support the mental health of those with diabetes and heart disease, without replacing them with new measures of equal weight, would have “very damaging consequences.”
The British Psychological Society said it was “astonished and disappointed” at the plan for the indicators to be dropped “rather than, as we had hoped and expected, improved and replaced,” while the Mental Health Foundation said the move would renege on the pledge made by the coalition government to treat mental health problems as of equal importance to physical illnesses.
“We’d be happy to see informed debate about the best indicators to use, but removing them completely from QOF would give quite the wrong message about how important it is to ensure patients get timely and effective treatment for depression,” said the Foundation’s chief executive, Dr Andrew McCulloch.
Dr Ian McPherson, chief executive of the Mental Health Providers Forum, added that the plan “would give the unfortunate message that there is no need to incentivise the treatment of one of the most disabling conditions in primary care for which effective interventions are increasingly available,” while Steve Shrubb, director of the NHS Confederation’s Mental Health Network, said that, imperfect as the indicators are, it would be “reckless” to remove them from QOF until suitable alternatives are in place.
“Mental ill health costs the UK about as much as the entire NHS budget every year,” said Mr Shrubb, adding: “primary care is the first point of contact for the vast majority of people using the NHS, and one-third of GP appointments are mental health-related.”
NICE’s proposed new QOF menu for 2012-13 also includes three indicators on offering support and treatment for smokers, and two new indicators to assess levels of physical activity and provide a brief intervention to people with high blood pressure who score “less than active.” There is also an indicator to improve care for people with asthma, and a set of indicators on fragility fractures in osteoporosis patients.
“All new QOF indicators recommended by NICE have been carefully considered by the independent QOF Advisory Committee,” said Christine Carson, programme director of NICE’s centre for clinical practice. “Throughout the process, we have consulted widely with professional groups, patients and community and voluntary organisations. NICE has also tested the indicators across general practice to make sure they work,” she added.
The final list of indicators to be included in the 2012-13 QOF will be decided by NHS Employers (NHSE), on behalf of the UK health departments, and the General Practitioners Committee (GPC) of the British Medical Association (BMA). Final QOF indicators will be published by NHSE this winter.
