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Choppy ride ahead on the QOF

The QOF was always supposed to evolve over time to reflect advances in the evidence base and the GPC claims, not entirely convincingly, that a quarter of the framework has changed since its inception.

The QOF was always supposed to evolve over time to reflect advances in the evidence base and the GPC claims, not entirely convincingly, that a quarter of the framework has changed since its inception.

Ministers might reasonably retort that few of the changes have been substantive. Aside from the addition of CKD and depression screening, it's been more a case of fiddling around the edges.

But to respond to this stagnation by handing the future development of the QOF over to NICE may prove to have been an overreaction on the Government's part.

Anyone who picks over the details of the Department of Health's proposals will probably conclude that revolution, rather than evolution, is what's in store.

If ministers get their way, 40 of the current 92 clinical indicators will be thrown out of the QOF over the next four years to make room for entirely new targets.

Primary care minister Ben Bradshaw says the new process will ensure he gets 'best use' of his £1bn 'annual investment in the QOF'.

This apparently anodyne statement masks a complicated history that may offer a better guide to ministers' motivation for a wholesale overhaul of the QOF.

GPs will remember well the shock in Whitehall when practices 'overachieved' massively in the first year of the QOF, landing the DH with a bill £100m more than it had bargained for.

Ministers had only themselves to blame for agreeing to a deal that amounted to rewarding GPs with performance pay for doing what, in many cases, they were already doing anyway.

But it's hardly surprising they've been casting around ever since for a way to wriggle out of the hole they dug themselves. Now they have their answer: adding a new cost-effectiveness criterion to the evaluation process that decides which targets make it into the QOF.

Under the proposed process, any indicator that merely rewards GPs for the workload involved in delivering high-quality patient care will be 'retired'. Only indicators that pay GPs for taking on new work are likely to survive the cull.

So GPs must brace themselves for a dramatic toughening up of the QOF over the next few years, with a huge raft of new indicators to get to grips with. The changes will take effect just as the scrapping of the square root prevalence formula sees thousands of practices struggling to cope with huge falls in their QOF pay.

GPs are clearly in for a choppy ride. No doubt they will rise to the challenge and surprise ministers once more with their ability to adapt to change.

But evolution rather than revolution may have been a more sensible option.

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