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NICE reveals raft of new primary care indicators for diabetes

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The National Institute of Health and Care Excellence has launched a raft of new performance indicators for primary care providers, aimed at improving care for people with diabetes.

In all, nine new indicators will be added to a list used to inform negotiations for next year’s Quality and Outcomes Framework (QOF) – the payment-by-results scheme for general practice.

“A number of the new NICE indicators for people with diabetes take account of frailty”

Gillian Leng

Eight of these focus on diabetes and will help GPs identify people who would benefit most from tighter control of their diabetes and support the personalisation of care, according to NICE.

This could include stopping treatments that are not really helping.

The addition of the new indicators to NICE’s QOF menu follows a consultation during the summer.

Since the draft document was released, three indicators have been added which back up existing NICE recommendations on cardiovascular risk assessments and statin treatment for people with type 2 diabetes.

Another on the use of statins by people with type 1 diabetes has been updated.

“The intent of these indicators is to reduce the risk of treatment-related harm and improve the quality of life”

Gillian Leng

The new indicators use “stratification” – narrowing down patient groups by multiple factors – based on whether or not a patient has moderate or severe frailty to set treatment targets and reduce the risk of cardiovascular problems.

NICE said the new approach, which is in line with recommendation from a recent review of the QOF in England, would improve patient outcomes and decrease the risk of harm from overtreatment.

The review recognised that developing indicators that apply to everyone with a particular condition could “‘inadvertently result in both the over-treatment of patients with severe needs, and the under-treatment of less complex patients”.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said the indicators would help ensure care was tailored to people’s needs.

“A number of the new NICE indicators for people with diabetes take account of frailty and are a step towards helping enable the greater personalisation of care,” she said.


Gillian Leng

“The intent of these indicators is to reduce the risk of treatment-related harm and improve the quality of life for people with moderate or severe frailty,” she noted.

The ninth new indicator concerns atrial fibrillation – a type of abnormal heartbeat. It suggests GPs should establish and maintain a register of people with atrial fibrillation or AF – including patients recorded as “AF resolved”.

The new NICE indicators will be used to inform negotiations for the content of the 2019-20 QOF, the voluntary annual incentive scheme for all GP surgeries in England.

The content of the QOF is determined through negotiations between NHS England and the General Practitioners Committee of the British Medical Association.

NICE has no involvement in these negotiations.

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