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News – November 2011
NICE recommendations for QOF 2012/13 have been agreed
NHS Employers and the British Medical Association have accepted recommendations from NICE on changes to the quality and outcomes framework (QOF) indicators for 2012/13.
Amendments for next year include:
- the retirement of seven indicators (AF4, CHD13, QP1, QP2, QP3, QP4 and QP5), releasing 45 points
- the replacement of seven indicators with eight NICE-recommended replacement indicators that focus on six clinical areas—asthma, atrial fibrillation, depression, diabetes, mental health, and smoking
- the introduction of nine new NICE-recommended clinical indicators and two new clinical areas—peripheral arterial disease and osteoporosis
- the introduction of three new quality and productivity indicators that focus on accident and emergency attendances
- raising all lower thresholds for indicators currently
40%–90% to 50%–90% - a number of changes to the upper threshold for indicators: CHD6, CHD10, CKD5, COPD10, DM17, DM31, HF4, PP1, PP2, STROKE6, and STROKE8.
Guide for GPs on supporting carers is launched by RCGP
The Royal College of General Practitioners and The Princess Royal Trust for Carers have released Supporting carers: an action guide for general practitioners and their teams. Carers are essential to the delivery of both healthcare and social care, and GPs and their teams are in an ideal position to help and support them. The revised guide focuses on supporting carers and includes advice on:
- identification of carers
- understanding their needs
- involving them in care planning.
The guide highlights physical, psychological, and other effects of caring that the primary care team needs to be aware of and includes:
- real-life case studies
- checklists
- practice action plans
- signposts to resources.
NICE publishes guideline on hyperglycaemia in ACS
Hyperglycaemia is a strong indicator of poorer survival chances and increased risk of complications, but remains an overlooked risk factor in acute coronary syndromes (ACS) and is often left untreated. NICE has published a guideline on the management of hyperglycaemia in people with ACS, such as myocardial infarction or unstable angina. It covers recommendations on:
- management of high blood sugar levels within 48 hours for people admitted to hospital for ACS
- identification of patients with hyperglycaemia who are at high risk of developing diabetes
- advice and monitoring for patients with hyperglycaemia after an ACS without known diabetes.
NICE recommends ticagrelor for the treatment of ACS
Ticagrelor in combination with low-dose aspirin is recommended for up to 12 months as a treatment option in adults with acute coronary syndromes (ACS); that is, people:
- with ST-segment-elevation myocardial infarction (STEMI) that cardiologists intend to treat with primary percutaneous coronary intervention or
- with non-ST-segment-elevation myocardial infarction (NSTEMI) or
- admitted to hospital with unstable angina defined as ST or T wave changes on electrocardiogram suggestive of ischaemia plus one of the characteristics detailed in the guidance (e.g. age ≥60 years, previous myocardial infarction or previous coronary artery bypass grafting, coronary artery disease with stenosis of 50% or more in at least two vessels). Diagnosis of unstable angina should first be confirmed, ideally by a cardiologist, before continuing ticagrelor beyond initial treatment.
Mifamurtide recommended for use in osteosarcoma
Mifamurtide has been recommended as a treatment option for osteosarcoma in children, adolescents, and young adults by NICE. Technology Appraisal 235 recommends mifamurtide within its licensed indication for the treatment of high-grade resectable non-metastatic osteosarcoma if:
- it is given in combination with postoperative multi-agent chemotherapy and
- the patient has had macroscopically complete surgical resection and
- mifamurtide is made available at a reduced cost to the NHS under the patient access scheme.
Ethics of commissioning guidance published by RCGP
The Royal College of General Practitioners has produced guidance Making difficult choices—ethical commissioning guidance to general practitioners. This publication is aimed at all GPs, especially those who will have a role as commissioners in clinical commissioning groups. It proposes that commissioners should aim to use limited resources to do as much good as possible while valuing each person’s life worthy of equal concern. Topics covered include:
- fair allocation of resources
- GPs as commissioners
- potential conflicts of interest.
The guidance accepts that there are no right answers, but aims to provide advice to assist GPs in making difficult decisions. Scenarios are used to illustrate and apply the ethical commissioning framework.
Guides on CHF and cardiac rehabilitation are available
Guides on services for people with chronic heart failure (CHF) and those who need cardiac rehabilitation have been published by NICE. The guides are aimed at supporting commissioners in designing services to improve outcomes for patients and to help the NHS use its resources in the most effective way. The advice within these publications reflects the recent NICE quality standard and clinical guideline for CHF and is aligned with the outcomes and indicators specified in the NHS Outcomes Framework. It is recommended that the following are considered when commissioning services for CHF and cardiac rehabilitation:
- The whole care pathway for cardiovascular disease and long-term conditions
- Integration across healthcare, social care, voluntary, and community services.
NICE releases guide on services for mental health disorders
NICE has published a guide on commissioning high-quality services for people with common mental health disorders. The guide recommends:
- a stepped-care model as the basis of service provision
- a multiagency partnership approach
- commissioning for outcomes—increasing the proportion of people with common mental health disorders who are identified, assessed, and receive treatment in accordance with NICE guidance, and the proportion that go on to make a clinically significant improvement or recover.
Information on specifying services for each step in the stepped-care model, examples of service models, and a commissioning and benchmarking tool are included in the guide.
The Department of Health has released its cold weather plan for England
The plan provides advice for individuals, professionals, communities, and agencies on how to be ready for and respond to severe cold weather. It works through a system of cold-weather alerts that will trigger appropriate actions.
Guidance on developing bereavement services has been published
Guidance on developing bereavement services has been published. It describes the principles of bereavement services, care in the days before death, at the time of death, and in the days following death. It also covers workforce training and education, commissioning, and quality outcomes for bereavement care.
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Guidelines in Practice, November
2011, Volume 14 (11)
© 2011 MGP
Ltd
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