NICE proposes targets for clinical commissioning groups

Authors: Adrian O’Dowd 

Publication date:  07 Aug 2012

The National Institute for Health and Clinical Excellence (NICE) has published a proposed menu of commissioning outcomes framework (COF) indicators by which clinical commissioning groups (CCGs) will be held to account.

The 44 indicators recommended by the COF advisory committee include targets on cancer mortality, care after a stroke, emergency admissions, and patients’ quality of life. [1]

Several doctors’ representatives and charities have raised doubts over the indicators, saying that there are too many and that they may be too rigid to allow doctors trying to commission the necessary freedom to succeed and be innovative.

The proposed indicators cover domains and topics such as preventing people from dying prematurely, enhancing quality of life for people with long term conditions, and aspects of care given immediately after a stroke and after hospital discharge following stroke. Diabetes, cancer, chronic obstructive pulmonary disease, maternal care, and mental health services also feature on the list.

NICE said that the indicators had been identified and developed from three sources: the NHS Outcomes Framework, NICE quality standards, and other existing indicator collections, such as national audits.

The NHS Commissioning Board will decide on the final indicators to feature in the 2013-14 framework in the autumn.

Gillian Leng, deputy chief executive and director of health and social care at NICE, said, “Each indicator has been through public consultation and feasibility testing, so commissioners can be reassured that they will work in practice.

“By setting out the aspects of care that are essential in facilitating the best health outcomes, the quality of care being commissioned for local populations can be measured. This will enable the groups responsible for commissioning NHS care to be held to account, and will ultimately drive up the standards of health care delivered.”

The BMA was sceptical of the indicators in their present form, and the chairman of its General Practitioners Committee, Laurence Buckman, said, “Clinical commissioning has the potential to deliver real benefits to patients, but we must not undermine the freedom of clinicians to shape local services by introducing a rigid tick box culture linked to an unethical system of financial incentives.

“We must instead have a flexible, open approach that encourages innovation and patient focused commissioning decisions. Indicators need to be sensitive to the health needs of local populations and allow commissioners to tailor services to what local people want and deserve, while observing effective benchmarking and performance management practices.”

Michael Dixon, chairman of the NHS Alliance, said, “Most of the indicators look eminently sensible and are very evidence based.

“But clinical commissioning groups are going to be the new innovators, so it’s really important that we do not hem them in, having to fulfil lots and lots of quality indicators when they might have other priorities.

“If they spend all their time dancing to the tune of the COF indicators, they may lose the buy-in and the enthusiasm of some of their frontline clinicians.”

The only cancer indicator listed in the framework is the under 75 mortality rate from cancer. Ciarán Devane, chief executive of the charity Macmillan Cancer Support, said, “We are shocked that it has been recommended that the framework—which will be used to hold the newly reformed NHS to account—will not include key cancer survival indicators. This means commissioners will lack strong incentives to improve cancer survival rates.”


  1. NICE. Commissioning Outcomes Framework (COF) indicators. [Link] .

Adrian O’Dowd London

Cite this as BMJ Careers ; doi: