Ministers set to consider a 'rolling QOF'
By Lilian Anekwe
The Department of Health is planning to scrap a series of clinical indicators in the QOF it feels no longer need to be incentivised in order to make way for new clinical areas.
Ministers are considering a rolling QOF that swaps indicators in and out on a cyclical basis – allowing them to add in new elements without increasing the incentive cash paid to GPs.
A document seen by Pulse reveals that the DH plans to redevelop the QOF in line with recommendations made by Professor Martin Roland, director of the National Primary Care Research and Development Centre, and reported exclusively in Pulse in January.
Professor Roland, one of the architects of the QOF, advised that it should be reduced in size and that indicators be swapped in and out every three or four years.
Responding to a parliamentary question, Baroness Thornton, Labour spokesperson for health in the House of Lords, writes: ‘In line with Professor Roland, we believe the QOF should evolve.
‘It should not be expected to grow year after year, but some indicators should be replaced, for example where behaviour has become part of standard practice and no longer needs to be incentivised.'
Professor Roland has suggested areas such asthma could appear in the QOF only on a cyclical basis, while the DH has also considered streamlining the framework by merging cardiovascular indicators into one – tacking ‘double-counting'.
Professor Helen Lester, chair of the QOF review panel, told Pulse the expert review panel of which she is chair had long advocated an evolution of the QOF.
She added: ‘We have also argued for the need to both pilot new indicators and remove existing ones when they have become part of the fabric of primary care. The difficulty is there is little evidence on the effect of removing an incentivised indicator on GPs' performance.'
The move came as new qualitative research, published in the Journal of Health Services Research and Policy, found GPs reported ‘substantial improvements' in conditions incentivised by the QOF, but not for unincentivised conditions.
Dr Susan Maisey, teaching fellow in health policy and practice at the University of East Anglia, said a rolling QOF would be a good way of ensuring conditions were not left out.
‘There is variability of care depending on whether a condition is incentivised. In particular, areas such as osteoarthritis and depression have missed out.'Ministers will revamp the QOF to fund new clinical areas