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GPC will fight to remove 'bureaucratic' elements of QOF, new chair announces

The GPC will fight for the removal of ‘bureaucratic’ and ‘non-evidenced based’ elements of the QOF in negotiations over next year’s contract, new GPC chair Dr Chaand Nagpaul has announced.

In his first letter to the profession, Dr Nagpaul said he would argue for the removal of the box ticking elements of the QOF that make demands on GPs’ time but do not benefit patients.

He added that the GPC will also tackle the problem of excessive and relentless workload as a priority, which will mean lobbying for investment in premises and staff. The GPC will send out a survey to all GPs soon, to ascertain the workload pressures caused by the contract imposition.

The letter, sent to all GPs on 21st August, said: ‘With 2014-15 contract negotiations just about to get underway, GPC will argue for the removal of elements of the QOF that do not benefit patients, the removal of bureaucratic and non-evidence based demands on our time and to reduce our workload to manageable levels.

‘To support these early talks, we will shortly be emailing all GPs in England a brief survey to provide us with a snapshot of workload pressures caused by the contract imposition.’

He added he wanted to champion general practice, which is ‘undervalued’ and ‘faces disinvestment’, and will forge a ‘renewed relationship with government’ demonstrating how investment in general practice could help manage pressures in the NHS.

In the autumn the GPC will publish their vision of how general practice could be developed to provide such solutions.

He added that keeping GPs informed and engaged was key, and promised more opportunities for grassroot GPs to shape policy, directly, or via LMCs.

Readers' comments (9)

  • Vinci Ho

    There is a major storm coming and the battles go on.
    ' Know what you've got and what your enemy've got , hundred battles , hundred wins' . Question is ,do you really know?
    All of us should be open minded and wish you luck , BUT........
    Sorry , there is always a but ,mate..........

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  • Ivan Benett

    I am very heartened by the stance taken by the new GPC chair. It is clear that we need more capacity in Primary care, and General Practice in particular. Where I think the GPC could be more progressive, is not to look to the Government for a solution, but the the profession itself.
    The CCGs, mostly run by GPs, totally embrace the principle of shifting resources from Secondary Care to Primary Care. Unfortunately, Primary Care, as it currently operates, is not in a position to accept that shift of activity and resources. To benefit from this unique opportunity GPs and Practices must be able to offer the services required to remove activity from secondary care, AND be paid for it of course. This will include increased capacity, workforce realignment and IT & premises development.
    So what is currently being provided in Secondary Care that could be done in Primary care? There is insufficient space here to offer a full list but I give you five easy wins.
    1. Stop the 30% or so follow ups that are currently unnecessarily being done because junior doctors don't feel confident enough to discharge back to primary care. Most stable longterm conditions can be seen by a Primary care clinician, with quick access back if necessary.
    2. Filter out the 30% or so referrals that don't need a secondary care opinion but could be managed by colleagues in Primary Care
    3. Make it easier for people to access Primary care (GP, pharmacy and other community) for urgent care advice and assessment, rather than pitch up in A&E. This accounts for 20-30% of attendances.
    4.Make sure ALL people with longterm conditions are identified and managed optimally so as not to need admission - eg. most heart failure medication is based on trials that dramatically reduce admissions
    5. Eliminate the 30% or more prescribing waste that happens because of ineffective, unnecessarily expensive or untaken medication.
    The GPC should promote a delivery structure that CCGs can feel confident in commissioning from - Primary Care provider organisations of various kinds are springing up in enlightend parts of the country to deliver on this shift of activity, with appropriate governance structures.
    There is much detail that space just doesn't allow for here, but the GPC could be a champion for this approach. Rather than presiding over the grumbling of General Practice, Dr Nagpaul could lead its recovery.
    I would be happy to work with the GPC to develop such a prospectus.

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  • Problem with Ivan's proposal is, surgeries are being asked to take a risk in order to invest into making changes. This may work in private sector where good investment may be rewarded by profit. In NHS, there is no return - partners would be called lazy, overpaid buffoons if the increase their drawings. Instead we would be burdened with yet more work to ensure any increase in our profits are kept to minimum (or currently, into deficits!).

    So NHS will either have to change the culture and allow successful surgeries to make substantial profits (but then you might as well have big private company), or such investment has to be done by a central body without affecting each practice's funding.

    At the moment it's neither. We are been told to do more work with less funding that will only lead to one thing - withdrawal of non essential service. We are already talking about cutting some service such as travel clinic which we do not get paid for and is not in our core contract.....

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  • Ivan Benett

    Dear Anonymous, A GP provider organisation IS a private company able to raise investment money and pay back - just as a GP surgery is now. You invest to make money...and get paid by improving services. Taking money from Secondary Care to pay for improved Primary care services has been done small scale in some LESs, e.g. our heart failure LES in Central Manchester where we halved hospital admissions.
    Now it's time to do it big style. In my CCG there's £1m of patients attending A&E who could be managed in Primary Care with more effective access arrangement - many examples of where that has worked - see HSJ last week.
    We call ourselves business people, now it's time to prove it. There is a great opportunity at the moment, and GPs remain in control of the agenda, if only we can see it and grasp it.

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  • Umm, not sure if you are a GP but that's not how it works.

    I'll give you an example - this year new DES are being funded by retiring QoF indicators. The QoF indicators were done by my admin staff which I've set up to run many years ago. Now I'll need clinicians, not admin to get back this money. More time invested by me to organize, we'll somehow have to find clinical time to do this, and I'll still have to pay admin as I did last year. And none of these have been proven to "cost effectively improve" overall patient care.

    So to put it simply:
    Risk - financial loss by employing more staff & buying equipments, clinical time lost by partners investing time and delay in development of other areas. Raising Pt expectation which then may not become sustainable
    Benefit - possible better patient care but any financial benefit which arises from this is to the treasury, not the individual practices.

    There is no financial reward for improving patient care. yes, there is a moral reward but we can't keep on putting ourselves in risk for moreal reward - just like a private investor wouldn't.

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  • We all know the management jargon.

    Change can be an opportunity or a threat, blah blah blah.

    We all know the reasons why more top-down change is being proposed -- essentially the wish to squeeze more out of the system because within the current centrally controlled system resources are limited but demand is infinite, rising demand currently being fuelled by an ageing population, medical advances and increased expectations.

    Congratulations to Ivan for embracing change -- the reward I suspect will be, once 30% of this and 30% of that has been taken on in primary care, to be asked to repeat the exercise ad infinitum (does anybody remember when it was considered normal for complex chronic diseases to be reviewed periodically in the hospital outpatient clinic -- I do).

    Many of us are becoming tired of this game and propose therefore to leave the pitch, the mechanism being VER -I propose to join them as soon as is practicable.

    There are many options for locum work if one wishes to continue working -- the advantage being that this will be on the basis of a well-defined contract, stipulating the remuneration required for a given workload.

    One can only wish those remaining in the system the very best of luck with their sisyphean toil.

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  • Best way to remove QOF is to emigrate. Cost me £30K to leave UK with my family. Now earning more money and paying half the tax. NHS primary care is a sinking ship. Make like a rat and leave. Come back when it collapses and primary care is a private service.

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  • Ivan, here in NI GP land is different. The more clinics I provide, the more services and appointments, the less I take home. My £60 profit per year remains the same. If I do an evening surgery or an early morning surgery I pay for the staff and heating etc. If I use Liq N, I pay for it as I do for dressings, stitch cutters etc.
    Besides all this why stay in a system where we have to FIGHT all the time. We are doctors and should leave any system that has WAR and such like in it. I say to Dr. Nagpaul - this game is not worth it.
    Every GP who can leave is leaving. Everyone who stays is depressed and burnt out. The GPC should and must represent its members. Society needs doctors. Let us forget about fights, battles, wars.
    Ballot about leaving this discriminatory [ ie pensions], bullying NHS.

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  • Anon 602 is right. All these battles, fights, wars. All GPs are tired of this constant bitterness, in spite of seeing 40 + patients a day. I really do not know why we stay. Please Chand WHY really do we stay in this WAR zone. Is there any peace, any life leisure balance out there? Are GPs and doctors not allowed basic human rights?

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