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NICE proposes QOF changes to include frailty in diabetes indicators

Practice nurses could have to work towards different blood pressure and blood sugar level targets for frail and non-frail diabetes patients, if proposed QOF changes go ahead.

The new indicators have been proposed by NICE in the hope that they will reduce under-treatment in patients with less complex needs and overtreatment in those with more complex care needs.

This comes after a review of QOF proposed cutting a quarter of the indicators but keeping the proportion of practice income provided by the framework the same.

The NICE proposals suggest that instead of two indicators – one for the percentage of diabetes patients in whom the last blood pressure reading is 140/80mmHg or less and other for a reading of 150/90mmHg or less – there should be just one for diabetes patients without moderate or severe frailty and a reading of 140/80mmHg or less.

Two indicators have also been proposed to replace three targets for IFCC-HbA1c, setting targets for those with (75mmol/mol or less) or without (58mmol/mol or less) frailty.

NICE said: ‘The current QOF indicators for diabetes are applied across all people with diabetes aged 17 years and above. By applying the indicators to all people with diabetes regardless of co-morbidities it may inadvertently lead to both under-treatment and overtreatment.

‘People with diabetes with less complex care needs may be undertreated, whilst people with complex care needs may be at risk of overtreatment.’

Additional changes were suggested to the total cholesterol target for diabetes patients, asking for the percentage of patients with diabetes and a history of CVD (excluding haemorrhagic stroke) who are prescribed a statin, instead of how many diabetes patients had a total cholesterol of 5mmol/l or less in their last test.

NICE also proposed adding people with resolved atrial fibrillation to the AF register, as they remain at a higher risk of stroke or transient ischaemic attack and continue to benefit from anticoagulation therapy.

The consultation on the proposed amendments ran from 18 July to 8 August 2018, with submitted comments now being reviewed by the NICE indicator advisory committee.