Changing the Quality and Outcome Framework
Please Take Action
With obesity rightly identified as “a major public health challenge to the United Kingdom,” the National Obesity Forum (NOF) believes that actively engaging with MPs and other policy makers is crucial to meeting this challenge. Our focus at NOF is on the quickest and most simple way to help overweight and obese people, and that is through better incentivising GPs to assist them. By reforming the GP incentive scheme, the Quality and Outcome Framework (QOF), we can help ensure that these individuals get expert, helpful advice on structured weight loss and weight management services as early as possible.
As part of the NOF’s active engagement with policymakers, we are asking for your help. Below is a readymade template to make it easy for you to write your local MP asking him to take up the issue of tackling obesity in the UK. Completing the enclosed letter and winning the support of your local MP will help encourage Government action on reforming the flawed QOF indicator on obesity.
If we can make policymakers understand the value and potential of QOF reform, not only will more people become aware of the challenges, but effective and sustainable action can be taken.
Background
Obesity is rightly identified as a “major public health challenge to the United Kingdom”, affecting around 26% of adults in England and over 27% of Scottish adults in 2011.
Given these alarming statistics, there is a clear need to help people to help themselves lose weight and live happier, healthier lives.
The QOF is a voluntary annual reward and incentive programme for all GP surgeries in England, England, Wales, Scotland and Northern Ireland. It currently has just one indicator point for obesity, which rewards GPs who make a register of the number of obese patients over 16 that have visited their practice.
There is a clear and pressing need to encourage and help GPs to assist the many obese and overweight patients that they see, not least by offering patients weight loss advice and support. Of course, the vast majority of GPs do this already but their efforts are currently not acknowledged by the NHS.
To address this problem are continuing to campaign, in partnership with Cambridge Weight Plan, to include a QOF indicator that rewards GPs for providing weight loss advice.
Such advice could involve GPs exploring with patients all possible weight loss options and possibly, should it be suitable for the patient, directing them to weight management services.
It is however important that this issue is now raised with other MPs and policy makers.
The Action
We would like you to write to your local MP, drawing their attention to our campaign and asking them for their support.
We are asking for MPs’ to sign an Early Day Motion (EDM) 293, entitled Obesity and the Quality and Outcomes Framework, which highlights the current burden of obesity and the importance of government action.
Objectives
1. Draw MPs’ attention to the need for a new QOF indicator ensuring that efforts to tackle obesity are properly recognised, in line with the recognition given to other public health campaigns such as that against smoking.
2. Ask for MPs’ assistance with this issue, including signing Early Day Motion 293 to raise awareness amongst Parliamentarians of this campaign and writing to the Secretary of State, Jeremy Hunt MP
The Toolkit
This toolkit contains instructions on (i) how to remind yourself of the name of your local MP, if necessary, (ii) a suggested letter for you to send to your MP; (iii) a copy of the Early Day Motion; (iiv) the briefing note jointly drafted by the National Obesity Forum and Cambridge.
The draft letter we have prepared will make more of an impact with your MP if you personalise it by adding information on your work and the impact of obesity in your local area.
Please also ensure that you keep NOF informed of any contact that you have with your MP, including the response that you receive to your letter.
How to find your MP
If you need to, you can remind yourself of your MP’s name by visiting the following website http://www.theyworkforyou.com/ and entering your postcode, or by calling the House of Commons information line on 020 7219 4272.
Further Information
If you need any further help, then please contact Sam Blainey at the Whitehouse Consultancy, who are helping NOF on this campaign:
020 7463 0689
Appendix 1: A draft letter to your local MP
[letterhead ]
……………MP
House of Commons
SW1A 0AA
[DATE]
Dear ………………….
I live at [insert your address here] within your constituency and I am writing to you about the urgent issue of the UK’s obesity epidemic and some practical, simple steps that we can all take to tackle this problem, which, if unresolved, will bankrupt the NHS.
Already the NHS Information Centre estimates that 26% of the country is obese. Unless bold action is taken - and quickly - the predictions of 2007’s Foresight Report will come to pass, with 60% of the UK population being overweight/obese resulting in countless avoidable deaths and a loss to the Exchequer of some £50bn per annum.
As a clinician and supporter of the National Obesity Forum, which has been working since 2000 to raise awareness of the emerging epidemic of obesity and the effect that it is going to have on both individuals and the NHS, I am also all too aware of the human cost that obesity can impose.
While the Coalition Government has taken some small steps in the right direction, notably with the release of their strategy A Call for Action on Obesity in November 2011, the focus remains on how to prevent obesity, which does nothing to help the millions of people already overweight and obese.
There is a quick, simple way to help overweight and obese people and that is through encouraging and helping GPs to assist them. For many overweight/obese people, their GP is the first health professional that they will see and the vast majority of GPs will give them some advice on losing weight and living healthier lives. It is, however, only through reform of the GP incentive scheme, the Quality and Outcome Framework (QOF) that we can ensure that GP’s efforts in tackling this major public health challenge are appropriately recognised.
It is crucial that GPs are appropriately rewarded for helping their patients lose weight, given the illnesses related to obesity, including type-2 diabetes, cardiovascular problems, some cancers, hypertension or osteoarthritis, and the economic costs that these impose. The QOF currently recognises GP’s work in simply registering obese people who come to see them - GPs can easily do that, but merely drawing up a register will not prevent a single overweight person from developing type-2 diabetes or a single obese person from having a heart attack.
Including a QOF point on tackling obesity will raise the profile of the issue and help GPs continue to improve their advice to patients on the best ways of losing weight and maintaining this weight loss.
You may already be aware that the on-going campaign to reform the QOF, backed by the National Obesity Forum, the UK’s leading obesity charity, and Cambridge Weight Plan. A full briefing note on this campaign can be found enclosed.
If you have not already done so, please consider signing Early Day Motion 293, entitled Obesity and the Quality and Outcomes Framework, which seeks to raise awareness of the current burden of obesity and the importance of action. For your convenience, a copy of this Motion is enclosed.
Please also consider writing to Secretary of State, Jeremy Hunt MP, raising this issue with him. We need Government support to galvanise all the other bodies interested in this issue to take the problem of obesity seriously and ensure that GPs are given the incentives to tackle the problem.
Thank you for considering this request.
Yours sincerely,
[Name & Address]
Appendix 2: Early Day Motion
EDM 293 Obesity and the Quality and Outcomes Framework 24.06.13
Total number of signatures, to date: 32
David Amess
Kevin Barron
Peter Bottomley
Gregory Campbell
Martin Caton
Michael Cannarty
Jeremy Corbyn
Jim Dobbin
Nigel Dodds
Mark Durkan
Andrew George
Mary Glindon
Roger Godsiff
Mike Hancock
Lady Hermon
Kelvin Hopkins
George Howarth
John Leech
Elfyn Llwyd
Naomi Long
Dr William McCrea
John McDonnell
Grahame Morris
Margaret Ritchie
Steve Rotheram
Chris Ruane
Bob Russell
Andy Sawford
Jim Shannon
Virendra Sharma
David Simpson
Joan Walley
That this House notes that obesity and being overweight affects almost two-thirds of the British population; further notes that the World Health Organisation has found that 44 per cent of the diabetes burden, 23 per cent of the ischaemic heart disease burden and 41 per cent of certain cancer burdens are attributable to being overweight and obese; believes that treating such conditions will impose a considerable financial burden on both the NHS and society as a whole, which the 2007 Foresight Report estimated could cost society £50 billion per year by 2050; further notes that action needs to be taken now to better incentivise primary care professionals to advise and recommend appropriate guidance and support for obese and overweight patients; welcomes the National Obesity Forum campaign to reform the GP incentives scheme, the Quality and Outcomes Framework; and calls on the Government to support this campaign in order to tackle the impending obesity epidemic.
Obesity & the Quality and Outcomes Framework (QOF):
the need for reform
A Briefing Note for Policy Makers - September 2013
Key Issue - Summary
Obesity is rightly identified as a “major public health challenge to the United Kingdom”, but the QOF which is a voluntary annual reward and incentive programme for all GP surgeries in England, Wales, Scotland and Northern Ireland fails to incentivise GPs to take any action beyond merely registering obese patients over 16 that have visited their practice.
With obesity affecting around 26% of adults in England and over 27% of Scottish adults in 2011, according to official data, it clearly is not enough merely to register patients as obese. There is a clear and pressing need for GPs to do more, not least to offer patients weight loss advice and help. This is an absolute priority for the health of the patients concerned, the health of the nation, and the future sustainability of the National Health Service.
The links between type 2 diabetes and obesity are firmly established and it is clear that without appropriate intervention obesity can develop into diabetes over a relatively short period of time. For instance, the risk of developing type 2 diabetes is up to 13 times more likely for people who are obese compared to lean people. Academic sources have estimated that the predicted increase in obesity rates over the next 20 years will result in more than a million extra cases of type 2 diabetes.
Obesity - Consequences and Impact
About one in four adults today are regarded as being obese and that number is rising. Unless bold action is taken quickly the predictions of the Foresight Report (2007), which foresaw 60% of the UK population overweight or obese by 2050, will come to pass. The resulting costs to the NHS could be in the region of £10 billion a year, with wider costs to society reaching nearly £50 billion a year. In particular, the total NHS costs of diabetes attributable to overweight and obesity would increase by 75% in the next 40 years, reaching £3.5 billion in 2050.
Yet, obesity policy in the UK is largely limited to promoting prevention and recording its prevalence. This standalone priority is certainly not going to solve the issue of the already overweight and obese members of society. Government needs to prioritise management of obesity - identifying the spectrum of therapeutic options available and incentivising GPs to advise, prescribe and recommend appropriate guidance and support from the wide range of sources available in the community.
What is the QOF?
Introduced in 2004 as part of the General Medical Services Contract, the QOF is a voluntary incentive scheme for GP practices in the UK, rewarding them for how well they care for patients. The QOF contains groups of indicators, against which practices score points according to their level of achievement. In simple words, the higher the score, the higher the financial reward for the practice. The results are published annually. By assessing and benchmarking the quality of care patients receive, the ultimate aim of the QOF is to improve standards of care.
When QOF was first introduced as part of the GMS contract in 2004, the following principles were agreed on where QOF standards should apply:
· where responsibility for on-going management of the patient rests primarily with the GP and the primary care team
· where there is evidence of health benefits resulting from improved primary care
· where the disease is a priority in a number of the four nations
In the most recent QOF guidance document[1], the co-authors (the British Medical Association and NHS Employers) correctly identify tackling obesity as a “major public health challenge for the United Kingdom” and a high priority for health departments in all four parts of the UK.