Reduction in QOFs will impact osteoporosis detection and treatment

People living with or likely to develop osteoporosis are now at even greater risk of breaking a bone following the removal of two vital performance indictors from the Quality Outcome Framework (QOF).

Since 2012, GPs have been incentivised through the QOF indicators to keep a register of people with osteoporosis. However, as of February 2019, GPs are no longer required to ensure that patients are offered appropriate treatment.

The decision comes at a time when the fragility fracture burden is greater than many other chronic diseases including chronic obstructive pulmonary disease (COPD) and ischaemic stroke, and in spite of the 2018 Quality and Outcomes Framework Report that highlighted global recognition of ‘the treatment gap’, where patients with fragility fractures are not treated appropriately.

As a result of this treatment gap, we believe that at least 40% of women in the UK do not receive drug treatment in the twelve months following a hip fracture. With more than three million people in the UK now living with osteoporosis, the removal of the performance indicators will further increase the number of people not being identified as at risk or osteoporotic.

Alison Doyle, our Head of Operations and Clinical Practice, said: “This is deeply concerning and is putting patients at risk. The revised QOF does not reflect the importance of osteoporosis drug treatments which are effective in terms of cost and outcome. With the appropriate medical treatment, many of our beneficiaries can avoid low trauma or fragility fractures caused by osteoporosis.

“The indicators helped GPs to understand the significance of identifying their patients with osteoporosis, and those with fragility fractures. However, unless patients receive appropriate drug treatments, they will continue to suffer fractures that will devastate their lives and increase the economic burden on health and social care.”

Dr Stuart Eastman, our GP clinical adviser, said: “There has been confusion in primary care over the years because of lack of consensus over osteoporosis treatment. At the ROS we have supported primary care professionals with clinical decision-making tools such as the duration of treatment flowchart, which provides clarity on treatment and management of osteoporosis.”

A team at the University of Manchester reported to NHS England last year that retirement of QOF performance indicators led to substantial drops in performance by GPs practices, to levels in some cases lower than was recorded before the indicator was introduced.

The only remaining QOF indicator on osteoporosis requires general practices to maintain a register of patients with a diagnosis of osteoporosis and yet, despite the condition increasing in an ageing population, data shows that prescription rates for appropriate drug treatments have been falling since 2006.

With only 10 percent of people living with osteoporosis estimated to be on their GP register, the performance of primary care in meeting this remaining indicator is disappointing and means that the only remaining QOF indicator is underestimating the prevalence of osteoporosis and people are still not being identified:

“Unless we can increase understanding of the impact of this condition on individuals and on the healthcare system, so that GPs recognise the importance of the remaining QOF indicator, we are putting patients at increased risk of fragility fractures,” says Miss Doyle.

GP Sunil Nedungayil said: “The retirement of the two QOF indicators for osteoporosis is a backward step and demonstrates a fundamental lack of understanding of the condition. GPs are not identifying people at risk and the close link between frailty, falls, fractures and osteoporosis seems to have been missed. By not developing a health initiative to improve osteoporosis care in primary care, the government is failing to tackle the big issue of frailty.”

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