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Gold, incentives and meh

GPC delivers withering attack on QOF changes

By Lilian Anekwe

GP negotiators have issued a withering and wide-ranging attack on the Government's plans to tear up and rewrite the QOF in a move that shatters their fragile truce with ministers.

The GPC's response to the Department of Health's consultation on its plans for the QOF brands the exercise a ‘farce' designed to railroad GPs into accepting proposals that are ‘fundamentally flawed'.

It warns the Government's proposals – to hand control of the QOF to NICE and develop local versions of the framework – could ‘be construed as almost wilful reinterpretation of our contract negotiations'.

The detailed 5,000-word response sets out to deconstruct the Government's plans point by point, claiming that:

•plans for NICE to set up a primary care consideration panel could allow external stakeholders to ‘inappropriately and unduly' influence procedures

•NICE does not ‘sufficiently understand general practice' to control the QOF and its attempts to apply cost-effectiveness criteria will harm care

•local versions of the QOF would fragment the framework, cause ‘postcode healthcare' and ultimately widen rather than narrow health inequalities

•allowing PCTs to choose indicators would dilute the evidence base for the QOF and lead to indicators being selected because of ‘soft pressure group or Government priorities'.

The GPC is seeking urgent clarification on the process for deciding new indicators after the planned review by NICE, expressing concern that they could be imposed on GPs rather than negotiated.

And it described the proposal to scrap clinical indicators that do not meet the institute's £30,000 per quality-adjusted life year threshold as ‘a fundamental misinterpretation of the nature of QOF funding'.

Removing indicators once they had become embedded in general practice would mean GP workload would rise inexorably and ‘may reduce the effectiveness of the QOF, with the risk of quality actually reducing', the response warned.

GPC chair Dr Laurence Buckman issued a call to arms to LMCs, urging every one to make its voice heard before the consultation ends on 2 February.

‘It's essential every LMC submits a response. Though this is an English consultation the proposed changes will have an impact on the QOF across the UK. If 35,000 GPs say "this is a mistake and here's why", there's a remote possibility the Government will change its mind.

‘The use of the word consultation is a farce. The QOF has been a success and if the Government wrecks it through lack of engagement with the profession it will be a crying shame.'

Dr Richard Vautrey, the GPC negotiator who is leading on the QOF, said: ‘Repeatedly over the last few years GPs have become cynical about Government consultations that appear to be done deals before the process even starts. I hope that's not the case here too.'

But health minister Ben Bradshaw insisted: ‘We want to ensure practices continue to deliver improvements to care, and the system needs to evolve to support this. Asking NICE to manage a more independent, open process for QOF indicators will make the best use of our investment, allowing the QOF to respond to medical advances.'

How the DH plans to reshape the QOF

• In October, the DH launched a 12-week consultation on plans to overhaul the QOF by handing responsibility to NICE for a ‘new, transparent and objective process for developing and reviewing indicators'

Plans include:
– a review of clinical indicators by NICE
– introduction of a stakeholder panel of patients, carers and GPs
– a panel of independent experts to prioritise areas for new indicators
– piloting of new indicators in GP practices
– developing a bank of indicators to be selected locally

• The consultation ends on 2 February and it is proposed
that NICE will assume power on 1 April 2009

Dr Richard Vautrey: GPs increasingly cynical about 'consultations' Dr Richard Vautrey: GPs increasingly cynical about 'consultations'

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