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Majority of QOF should be local, claim NHS managers

By Lilian Anekwe

Funding for national QOF indicators should be reduced to just a small ‘core', with the majority of targets locally determined, health service managers are proposing.

The NHS Confederation told the Department of Health's consultation on its plans for the QOF that PCT managers were keen to take control of as much of the framework as possible.

It warned that there was a danger of ‘conflicts of interest' if GPs were allowed to influence the local indicators in their areas, and that PCTs would be ideally placed to choose the majority of indicators

The confederation said: ‘Members wish to see a small national core QOF that would allow the maximum resource to be made available to PCTs to invest in services, through a local QOF, that best meet population's local needs.'

David Stout, director of the NHS confederation's PCT network, warned the DH Health that it still needed to address many unanswered questions about the local QOF proposals before they could be made to work.

‘There are unanswered questions around how to match two or three parallel commissioning process, and there will remain problems with conflicts of interests involving GPs.

‘Would a local QOF menu be heavily influenced by GPs who will gain the most from QOF? That isn't addressed in the proposal,' he said.

Elsewhere, the confederation was far less enthusiastic about the DH's proposals to hand control of the QOF to NICE, which have come under fierce attack from GP leaders.

It warned the proposals were over-reliant on judgements of cost-effectiveness, and that aligning indicators with NICE guidance risked undermining patient care.

‘A focus on cost-effectiveness and clinical effectiveness possibly limits the gains that can be achieved,' it said. ‘Best practice is not always capable of being assessed through cost effectiveness.'

But the RCGP's response backed the GPC's insistence that the QOF should remain a national framework, with local priorities addressed through locally enhanced services, and questioned the ‘management ability' of PCTs.

‘Many of our members have raised concerns at the management ability of PCTs to deliver local quality improvement' the College's response said. ‘We are not convinced that local QOF could be managed by PCTs and it could adversely affect the consistence of care offered to patients', it continued.

The response came in the same week as RCGP chair Professor Steve Field called for a major PCT reorganisation and said the number of PCTs needed to be drastically reduced, as there are currently ‘too few high quality managers going round to service them.'

David Stout: director of the NHS Confederation's PCT network, says its members want to see a small national core QOF David Stout: director of NHS Confederation's PCT network

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