New primary care indicators focus on asthma and COPD care

The new suite of indicators could be added to the GP Quality and Outcomes Framework (QOF) from 2020-21, subject to contract negotiations between doctors’ leaders and NHS leaders.

“These new indicators should increase the likelihood of improved outcomes”

Gillian Leng

The new indicators suggested by NICE for inclusion are especially designed to improve the diagnosis and treatment of asthma, chronic obstructive pulmonary disease (COPD) and heart failure.

The options also include a range of indicators to support people in reducing their alcohol consumption and an indicator that can be used to measure multi-morbidity.

NICE’s latest menu of indicators has been developed to inform negotiations for the 2020-21 QOF in England. The framework is a voluntary annual reward and incentive for all GP surgeries in England.

It forms part of the General Medical Services contract and any proposed changes to the framework are subject to negotiations between NHS England and the BMA’s General Practitioners Committee.

A review of the current QOF indicators for asthma, COPD and heart failure was agreed following NHS England’s 2018 review of the framework.

Four of the potential new indicators are intended to help improve diagnosis and ongoing care for people with asthma, and encourage general practice staff to undertake an annual review.

NICE said the review should include an assessment of asthma control using a validated 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, noted NICE.

Professor Gillian Leng, NICE’s deputy chief executive and director of health and social care, 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,” she said.

Likewise, NICE said the suggested new COPD indicators recognised the importance of using objective testing to confirm a diagnosis of the respiratory condition.


Gillian Leng

The new indicators link diagnosis and objective testing to entry onto the QOF COPD register, said NICE, and should contribute towards a reduction in both misdiagnosis and the risk of overtreatment.

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, noted the institute.

Meanwhile, NICE has also developed indicators outside of QOF to improve outcomes for familial hypercholesterolaemia and support implementation of its quality standard on HIV testing (QS157).

These two indicators can be used to support quality improvement and measurement at a local level, said the institute.

NICE reviews and maintains its list of indicators to ensure they are in line with the latest guidance. New and updated indicators are added every year, usually in August.