features
Everyone's talking about...: Exercise and the QOF
What does it mean now that physical activity has been taken off the QOF, just one year after being added – and how can we get it reinstated?
The fitness industry was jubilant a year ago when exercise was added to the Quality and Outcomes Framework (QOF) – a voluntary scheme that rewards GPs for patient care – for the treatment of hypertension. The hope was that it would be the first step towards greater collaboration between the healthcare and fitness sectors, with physical activity embedded across a wider range of indicators for the management of chronic conditions (see HCM Jan 14, p5).
But after just one year, it’s been dropped in a dramatic slimming down of the QOF, which has seen QOF’s scope cut by a third. Just as we thought we were making headway in putting exercise on the radar of GPs who haven’t bought into it yet, it’s off the agenda again.
So what’s the reason for these cuts? Are there questions about the validity of physical activity as treatment for medical conditions, or does the issue lie with QOF itself – is it a dying tool? Physical activity is, after all, just one of many indicators to be removed this month, suggesting it’s less a reflection on the benefits of exercise and more about the QOF not working that well in general.
And might the whole thing be a political move? Last year, the Secretary of State wanted lots of indicators added; this year, following protest from GPs that they feel governed by tick boxes, a knife has been taken to QOF. GPs have also been given more freedom and new payment arrangements in return for longer opening hours and various other service enhancements.
According to ukactive, the take-up of the physical activity indicator within QOF was disappointingly low – it was deemed to be more hassle than it was worth financially and not seen by GPs as a priority area of focus. Would this change even if it were reinstated?
Either way, it’s still vital that we work to forge links with the healthcare sector and convince GPs that, whether exercise is on the QOF or not, they should be recommending it to patients. So what next? We ask the experts...
Stephen Wilson,
Public Affairs Director ,
ukactive
“If the UK physical activity sector is to become a crucial part of the public health machine, we have to improve and expand our research and delivery of cost-effective, evidence-based programmes that work in a real world setting. We also have to show that a health professional prescribing physical activity is offering a tangible benefit to improving the health of the nation.
The problem goes deeper and beyond the QOF. The real issue that needs to be challenged is that health professionals receive almost no training on the physiological and psychological benefits of physical activity, or its role in preventing, managing and treating chronic illnesses. It’s unreasonable to expect any significant use of exercise in primary care without such training. To become a health delivery partner to the medical community, we must continue to establish the evidence base for exercise as a health tool and demonstrate that it can be applied and prescribed by GPs.
Improving the training of primary care professionals and making evidence-based interventions available must be the next steps. ukactive is also working with key partners such as Public Health England to raise awareness of the health benefits of physical activity, and the negative impact of inactivity.”
Professor Colin Hunter,
Chair of QOF advisory committee ,
NICE
“There’s a rigorous testing process for anything to go onto the QOF, and it must be based on good evidence. Physical activity passed all of the criteria and has a good evidence base; its removal was based on the need to reduce the size of the QOF. Last year, lots of indicators were added; this year, the negotiators decided to remove one-third, because GPs reported the QOF was too burdensome and they felt managed by tick boxes.
I don’t think there’s any doubt among GPs that physical activity is positive, both mentally and physically, for most of the population. The doubt lays in how effective their own intervention would be on the patient, given that they only have a 10-minute consultation. However, many GPs and practice nurses are still recommending exercise, along with eating healthily, drinking less and stopping smoking.
Physical activity was included on the QOF for a relatively small subset of hypertension sufferers, so I suspect that the impact of its inclusion and removal will be fairly minimal.
Going forward, the fitness industry needs to be aware that much of the UK’s inactivity is a result of social inequality – many exercise initiatives currently exclude the most needy, and this needs to be addressed.”
Dr Telesilla Wardle,
GP,
London-based surgery
“Having always exercised, I’m a strong believer that exercise is medicine. I’ve been instrumental in setting up an exercise group in my locality, to which I refer my patients who have complex musculoskeletal and cardiovascular problems that require expertly guided aerobic activity.
As GPs we can advise, but we can’t make people take their medication, exercise or eat properly. This doesn’t give us the excuse not to keep trying though. I believe GPs who don’t like to prescribe exercise are often those who don’t lead healthy lifestyles themselves and haven’t invested in the benefits of exercise.
Taking physical activity off the QOF will negatively impact patients. The trial period was too limited to produce any statistically significant data, but this doesn’t deny its value.
For the Department of Health to continue using exercise as an indicator that contributes to health, I think the fitness industry needs to become less frightening to body-conscious people, as well as more approachable financially. I think it would also be helpful if the fitness industry were to strike up relationships with GP practices to help set up cheap, entry-level exercise in the community, similar to the one I’ve helped to establish in Haringey.”
Dean Hodgkin,
Consultant,
Ragdale Hall & énergie
“Within the fitness sector, we’re well aware that research shows exercise is a viable alternative to prescription drugs as a mode of treatment for many life-threatening health conditions, but this isn’t common knowledge among health practitioners, let alone the man and woman on the street. Including it within the QOF conveyed its importance as an effective intervention, both to GPs and to the public at large.
There’s no question that healthcare professionals, in some quarters, still require convincing of the value of exercise as an intervention so, as an industry, we must push for the proliferation of evidence-based studies.
Maybe their concerns centre around the integrity of our industry and our ability to deliver on our promise, so we must continue to drive the aspiration for high levels of service. A meaningful long-term partnership with the health sector can only exist if we can guarantee, at every point of contact, a quality exercise experience with understanding of, and appropriate advice for, members who present with health conditions. Operators and individuals must commit to ongoing training to upskill front-line staff, ensuring they’re comfortable in dealing with all health issues they might encounter.”
