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Ministers unveil plan for QOF to go local

Local versions of the quality and outcomes framework are set to be developed across the UK as part of plans to dramatically devolve the GP contract.

Ministers last week revealed plans to explore 'further flexibility' for local commissioners in response to MPs' demands for local quality targets.

NHS Employers said it would be discussing the plans with the Department of Health and the GPC, with insiders confirming local versions of the QOF formed a central part of the Government's long-term strategy.

The move to devolve the development of quality targets comes as the pressure grows to squeeze greater productivity from GPs with more and tougher targets.

It came as a new study found the care of conditions left outside the QOF – such as osteoarthritis and depression – had stagnated while quality had improved elsewhere (see below).

The department responded to a health select committee inquiry into workforce planning by setting out its strategy for future development of the QOF.

'It has always been open to PCTs to agree local quality incentives but in practice, the vast majority of practices take part in the national QOF.

'As part of the ongoing review of the QOF, the Government wishes to explore the scope for further flexibility for local commissioners to address local quality issues.'

Alastair Henderson, deputy director of NHS Employers, said: 'The idea of local flexibility to address local needs we would be interested in exploring. We will be discussing this with the department, the PCT network and the GPC in the future.'

Chris Town, former chair of the NHS Employers negotiating team, insisted the Government had always planned to give the QOF a 'local flavour', although he added: 'Minimum standards will need to be negotiated nationally.'

Former health minister Lord Warner first hinted at plans for local variations in the GP contract in an exclusive interview with Pulse earlier this year.

But the GPC attacked the plans. GPC chair Dr Hamish Meldrum told Pulse: 'The QOF is national and we have always believed it must be national. There are mechanisms for dealing with local priorities, like enhanced services, and there is no reason at all to change this.'GPs were unsure PCOs could be trusted to run local schemes.

Dr Veena Agarwal, a GP in Eltham, south London, said the key would be how the plans were implemented. 'We would really need support from PCTs if the QOF became a local thing and I don't know if we would get it.'

Dr David Jenner, NHS Alliance contract lead, said in principle he though it was a good idea, suggesting around 50 of the QOF's 1,000 points could be determined locally.

Politicians press for local schemes

Health select committee:

'The QOF should be used to negotiate more exacting targets for improving standards. The Government should consider allowing some QOF targets to be negotiated at a local level.'

Department of Health response:

'As part of the ongoing process of review of the QOF the Government wishes to explore the scope for further flexibility for local commissioners to address local quality issues.'

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