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Any value to going local?

The quality and outcomes framework is a prime example of the kind of grand national project of which this Government is so fond – an ambitious set of targets designed to push up standards in every corner of the UK. But ministers have now given a strong indication that they are ready to loosen their grip on their baby, and allow primary care organisations some scope to shape the QOF locally. The shift in policy is a tacit admission that not everything has turned out exactly as planned.

Just this week a study revealed the quality of care of conditions not included in the QOF has stagnated, as GPs understandably focus their attention on the quality targets. Against that backdrop, some degree of flexibility – to allow PCOs to take into account the specific health needs of their areas – might seem welcome.

Potential dangers

But there are dangers. The national QOF goes through a rigorous process of evidence review and negotiation. Its targets are – or at least should be – both achievable and demonstrably beneficial to patient care. If PCOs are let loose on the QOF, can they be trusted to assess the evidence as thoroughly, and is there a danger some will force through targets substantially tougher than the national standards?

Perhaps a compromise is in order. The GPC and NHS Employers should draw up a menu of local QOFs, so each PCO can choose the one that best matches its needs. That way, we get a more flexible local system, without exposing GPs to the risks of local managerial excess.

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