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Plans for latest QOF revamp target pregnancy risk factors

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General practices could in future receive financial incentives for questioning women with diabetes or epilepsy about their plans for having children in order to prevent placing unborn babies at risk.

Proposals for a new raft of financially-backed indictors for practices have been published by the National Institute for Health and Care Excellence (NICE).

The indicators have been developed for the 2014-15 Quality and Outcomes Framework (QOF), the payment mechanism through which practices are rewarded for hitting a range of healthcare targets – mainly linked to long-term conditions.

The proposed new additions to the QOF will be subject to consultation before they are introduced.

Several of the suggested new indicators are designed to encourage practice nurses and GPs to target women in their childbearing years.

They include asking practices to note the percentage of women with diabetes who are aged 17 or over, but under 45, who have been given advice in the previous year about contraception, conceiving and pregnancy.

Official data from the Centre for Maternal and Child Enquiries suggests women with type 1 or type 2 diabetes have a “significantly increased risk of adverse pregnancy outcomes”, compared to other women.

This includes a risk of stillbirth which is five times higher, an increased risk of the baby dying and a two-fold increased risk of congenital abnormalities.

These are caused by diabetes itself, lifestyle factors such as being overweight, but also side effects of the medications used to treat diabetic complications.

Establishing good blood sugar control before conception and continuing throughout pregnancy will reduce the risk of miscarriage, stillbirth, death and abnormalities, according to the new indicator.

Another indicator covers women with epilepsy who are aged 18 or over, but under 45, who are taking anti-epileptic drugs.

The proposed indicator would reward practices for offering patients information and counselling about contraception, conception and pregnancy.

Anti-epileptic drugs taken during pregnancy are associated with an increased risk of major congenital abnormalities.

Women in the general population have a 1% or 2% chance of having a baby with such abnormalities, increasing to just over 3.5% for women on one epilepsy drug and 6% for women taking two or more.

Research suggests only 46% of women with epilepsy who have had children were told before conceiving or during pregnancy that their medication might affect their unborn child.

Professor Gillian Leng, NICE deputy chief executive and director of health and social care, said: “These proposed new indicators for family doctors will help set high standards of care and improved results for patients.”

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Readers' comments (1)

  • Interesting that elsewhere in NT online, there is a thread about whether or not Nursing is a low status profession. Well here is further evidence that it is.
    Whilst nursing posts are culled countrywide, pay frozen and pensions attacked, the GPs are, once again, having money thrown at them. Several years ago, the King's Fund carried out a study which concluded there was NO evidence that this GP financial bonus scheme prevented illness or reduced health inequalities. Billions of pounds spent with little or nothing to show for it. The Quality and Outcomes Framework is just a tick box money maker for the GPs. Kerching!

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