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Independents' Day

Has the final QOF box been ticked?

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Making New Year’s predictions is a mug’s game. But (perhaps foolishly) Pulse is doing just that.

The QOF may have been one of the totemic features of the 2004 GP contract, but a Pulse investigation reveals it may soon be consigned to history.

We have discovered that 12 CCGs are looking at offering practices in their area an alternative to the QOF under co-commissioning, with some planning for this to be in place from April. They may retain some aspects of the framework, but they plan for all GP practices to say ‘bye bye’ to the national scheme and sign up for a new local contract.

CCG leaders see this as a landmark opportunity to better align the incentives given to hospitals and primary care services. And it would certainly seem to make sense to bridge the historic divide between both parts of the health service and have them working towards the same goals.

NHS England is championing the move, allowing CCGs who bid for full control of GP funding from April to jettison the framework without permission from local area teams.

But, of course, this all relies on the agreement of local practices. A Pulse survey last July found almost half of GPs would opt out of the QOF if their CCG offered an alternative. Some LMC leaders are actively championing a move away from the national contract.

The precedent has already been set in Somerset, where more than two-thirds of GP practices have ditched the QOF for an alternative regional scheme. GPs in the area say they are already noticing the benefits of being ‘liberated’ from box-ticking.

Not long ago, the QOF was regarded as a world-leading mechanism for remunerating practices for providing quality, evidence-based care to patients – but it strayed too far from its original remit.

After steady improvements in care during its early years, the positive impact of the QOF lessened, despite its growth as a proportion of practice income.

It became bloated, with many patient groups and lobbyists fighting for their pet cause to be included. NICE then took over the framework, contorting it to incentivise GPs to follow its clinical guidance.

The indicators became progressively more onerous and less evidence based. For instance, the inclusion of the PHQ-9 and GPPAQ questionnaires for depression and physical activity, and the infamous ‘quality and productivity domain’ undermined GPs’ professionalism and fatally eroded support for what was – at least initially – a decent idea.

The 2014 contract deal saw the tide begin to turn. Some 40% of QOF points were removed and the funds transferred to the global sum. The health secretary made the extraordinary claim that he’d get rid of the whole QOF ‘if he could’.

But it looks like co-commissioning may save him the trouble. If so, there would be far-reaching consequences for the whole GP contract – which is why the BMA is so opposed to the idea.

Negotiators argue that bidding farewell to the QOF will leave practices exposed and at the mercy of the vagaries of the funding system for CCGs. That is a concern, but confidence in the GPC to deliver a good deal for practices has been hit by recent experience.

Many GPs may prefer to take their chances on a local contract. If so, the demise of the QOF may just be the beginning of the end for the national GP contract.

2015 is going to be an interesting year.

Nigel Praities is editor of Pulse

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Readers' comments (7)

  • Not sure how our CCG (Redditch & Bromsgrove, I'm the chair/clinical lead) got to be listed in the Pulse article. We have no plans to replace QOF, haven't discussed it as a CCG. I wonder if Pulse has mis-interpreted our CCG's co-commissioning submission from earlier in the year. I was certainly interested in ditching the retiring 13/14 QOF indicators early, but am very cautious about quitting QOF, and we certainly have no plans whatsoever to offer our GPs any alternative to QOF from 1/4/15

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  • This information was contained in the joint 'expression of interest' in co-commissioning from Redditch and Bromsgrove and Wyre Forest CCGs that says both CCGs are considering 'local quality standards, as a potential replacement for the national Quality and Outcomes Framework'. We spoke with the press office to confirm this was still current and were told it was 'too early in the process' to make any further comment on these plans.

  • And the key question for any GP is what is your CCG planning?- they are membership organisations so should be performing in accordance with membership consensus view?
    I pity Jonathon Wells, he is clearly not aware of what his NHS management "support" team are doing.
    I regrettably conclude as in many CCG's the direction it's NHS management is taking it is not the direction it's members desire, as Jonathons comment shows me.

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  • confused Qof? no Qof?

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  • Need to watch for the draining off of the money , get rid of QUOF and give CCGs the funding less the administration top slice and in the contracts tie CCG s down to delivering the new style service with less money .

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  • QOF has changed general practice for the better and has provided an important justification for the long term continuance of our discipline. BEFORE QOF general practice was (quite simply) about what happened to come in through the door. AFTER QOF general practice was about continuing and holistic care of every patient on the list with a chronic or potentially chronic condition. It is true that many practices before QOF offered quality care to all their chronic patients, but this was far from universal, and most did not chase or encourage every one of their at risk patients to seek care. For over 50 years we had identifiable lists of patients, but did little to ensure that our care covered everyone at risk. When at last we were paid (and had the technology) to provide quality universal service and continuing care, we stepped up to the plate and changed the very essence of how we practised. QOF was sometimes barmy and ill-advised in detail, but in broad principle it worked and provided value for money. Let's continue to tweak it, but ensure that each additional task is adequately resourced. Abolish QOF and the money that pays for it will… just disappear into some daft politically inspired nonsense that will neither help our patients nor recognise the work we do.

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  • I agree

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  • qof is an idiotic bureaucratic inefficient often ridiculous time-wasting arbritrary over complex micromanaging needs replacing by a rational evidence based system of preventive care professionally driven and policed by professionally led peer clinical governance...not by a bizarre irrelevant mass of tick boxes that have created as we all know a system of gaming and coding that has very little to do with patient care.

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