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‘Local’ QOF could see workload surge

By Lilian Anekwe

GPs in the same PCT could be working under different QOF indicators under Government plans for a locally flexible quality framework.

The plans could sharply increase workload for GPs by allowing PCTs to pick targets their local practices most struggled to hit, a Department of Health analysis reveals.

Under the DH plans, more than 3,000 low-scoring practices might face tougher local QOF indicators than they would do if targets continued to be set nationally.

Allowing PCTs to select their own local indicators from a national menu agreed by the GPC and NHS Employers was a key plank of the consultation document on the future of the QOF, launched last week.

Worked examples in the DH impact assessment reveal that devolving choice of indicators would increase patient benefit – and make the QOF more cost-effective – by dragging up achievement in indicators in which practices currently struggled to get top scores.

If PCTs chose between the Atrial Fibrillation 3 and the Stroke 12 indicators – depending on which looked tougher based on past performance for each individual practice – the proportion of practices with more work to do to hit the 90% threshold would rise by 44%.

A further 1,312 practices would face more work, compared with if the QOF was set purely nationally.

Similarly, 2,617 – or 48% – more practices would have to improve to meet maximum thresholds if PCTs chose between DM20 or Smoke 02 for individual practices.

Assuming a choice of just one of the four indicators would mean 2,145 practices would be below the maximum level for at least one indicator – 78% more than under the current national QOF.

The DH has sought views on the local QOF proposals as part of the consultation, and says the modelling ‘illustrates there is significant potential for increasing patient benefit by devolving responsibility for choosing QOF indicators'.

But RCGP chair Professor Steve Field said he had concerns about shifting to a local QOF.

‘We are worried about fragmentation. Some PCTs might be able to make these decisions but we're not 100% convinced that across the country it would work well.'

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