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GPs face losses on QOF double pay

By Daniel Cressey

Ministers to consider single vascular domian to prevent 'double-counting' of QOF points

Ministers plan to shave money from GPs' quality pay by cracking down on 'double payments' for patients who appear on more than one disease register.

All vascular indicators could be unified to prevent GPs from being paid twice for the same work, experts leading the quality and outcomes framework review told Pulse.

A report prepared for the Department of Health by academics at the University of Nottingham calculates that a third of patients have more than one condition carrying quality points. It warns that with rising rates of comorbidities, future reviews of the QOF framework will need to look at ways of preventing double payment.

'There are five conditions broadly described as the metabolic disease – diabetes, hypertension, left ventricular failure, stroke and coronary heart disease – that commonly occur together and have similar values recorded in their indicators within new GMS,' it says.

A second report by Professors Helen Lester and Richard Hobbs – who are leading the QOF review – identifies the issue as a key inefficiency.

'At present, QMAS is not able to extract individual patient-level data so if someone is on two disease registers, entry of a single data point such as smoking status will effectively lead to double payment,' they write in this month's Family Medicine.

Smoking indicators were unified in a single domain in the last QOF review and Professor Hobbs, head of primary care and general practice at the University of Birmingham, told Pulse officials were examining ways to do this with other indicators too.

'There's some exploratory work looking at whether you can get single indicators that work across groups – you may have a single vascular indicator, for example. 'The difficulty is there are different targets for some markers, so measuring something twice may well be appropriate if they have different targets.'

Dr Donal O'Donoghue, the Government's renal tsar, said: 'It would be appropriate to review the QOF blood pressure targets and have an integrated vascular suite rather than CHD, diabetes and CKD domains. 'A single vascular domain would be likely to hold fewer points than the current individual indicators combined.

A department spokesperson insisted it did not regard double payment as a major problem but added: 'Inevitably, chronic diseases will occur together. We will look to improve the QOF over time to reflect the latest evidence, such as that in this report, to ensure we get the best value for money for patients.

'Dr Laurence Buckman, GPC deputy chair, said: 'It's not double payment. If there's comorbidity it's more work.'

Why a clampdown is in prospect

• Thirty-three per cent of patients treated under QOF are on two or more disease registers
• QOF review experts highlight 'double payments' as key inefficiency
• Department of Health report warns double-counting will be a growing issue as chronic disease rates soar
• Moves to introduce single vascular disease domain

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