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New quality framework means more cash faster

GPs will earn more money in quicker steps under a revised structure for the contract's quality and outcomes framework, negotiators have pledged.

A system of phased and tiered markers has been replaced by a series of smaller steps, it emerged at the special LMCs conference earlier this month.

The five-level phased and three-level tiered quality levels have now been broken down into much smaller increments.

Phased markers originally encompassed the three large disease areas of cerebrovascular diseases, cardiovascular diseases and diabetes.

These have been amalgamated with the tiered markers to form a final list of 11 conditions (see panel right).

Dr Brian Patterson, GPC Northern Ireland chair and a member of the negotiating team, told Pulse that if the contract went ahead GPs would now be rewarded for improving performance in a single clinical marker.

He said GPs could guess what most clinical markers would be: 'If you take ischaemic heart disease, you're going to be looking at blood pressures, lipid levels, aspirin and angina management.'

Dr Tony Snell, co-deputy chair of the NHS Confederation core negotiating team, claimed the revised framework would make GP work simpler and not more bureaucratic.

Under the new framework, GPs will also be able to secure additional bonuses in each clinical area if they simultaneously improve in their organisational markers and patient experience as well as clinical performance, said Dr Snell.

'There will be a lot of linkages to encourage achievement across the board,' he said.

Dr Patterson added: 'It's to try to encourage people not just to focus on clinical entities but all other aspects of general practice.'

But he reassured GPs they would not be penalised for focusing on a few clinical areas: 'It doesn't mean you have to be at the peak of everything.'

Quality framework

What has changed

 · Smaller thresholds for GP payments

 · Phased and tiered quality sections abolished

 · Bonus payments for improving clinical, organisational and patient satisfaction outcomes

11 clinical areas

 · Coronary heart disease

 · Left ventricular dysfunction

 · Stroke and TIA

 · Hypertension

 · Peripheral vascular disease

 · Diabetes


 · Epilepsy

 · Hypothyroidism

 · Mental health

 · Asthma

5 organisational areas

 · Records and information

 · Education and training

 · Communication

 · Practice management

 · Medicines management

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