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GPs go forth

QOF should be scrapped under 'new deal' for GPs, says RCGP

The RCGP is calling on the GPC to ‘replace QOF’, and has urged the Government to conduct an immediate review of the ‘unnecessary burden’ posed by CQC inspections in a bid to relieve the immense pressure on GPs.

In its ‘blueprint’ - which details how the Government can deliver on the Five Year Forward View to overhaul the NHS - the college calls for an ‘urgent full scale review into how the bureaucracy, red tape and unnecessary workload’ can be reduced and how to free up GP time to focus on ‘delivering high quality patient care’.

It says that the QOF is creating ‘unnecessary burdens’ on GPs, and says there should be new funding arrangements to replace it.

The RCGP also says that there should be an ‘immediate review’ of the role of the CQC, following the calls from the LMCs Conference to scrap the regulator, and a speech by Dr Chaand Nagpaul calling for an end to the inspection regime.

The RCGP’s plan for general practice - released in May to coincide with the election of the new Government - stressed the safety implications of general practice being ‘significantly overstretched’, as GPs are unable to make necessary innovations to ensure future patient care.

It said: ‘There are concerns that general practice does not have the capacity to withstand a major health crisis such as a national flu outbreak, and that GPs who want to spend more time developing new models of patient care are prevented from doing so by current pressure levels.’

This could partly be achieved by a review of QOF and the CQC, it said.

The report called for the Government to ‘immediately initiate discussions with the GPC to replace the QOF with a new funding arrangement that allows GPs more freedom to focus on providing the best possible holistic care to patients and eliminates unnecessary bureaucracy’.

The calls come after several CCGs have initiated moves to replace the QOF locally as part of plans to co-commission primary care, while health secretary Jeremy Hunt has said he would ‘scrap QOF if I could’.

The RCGP similarly called for an ‘immediate review of CQC inspections and regulatory processes to eliminate unnecessary burdens for  general practice, and to ensure that scrutiny is focussed in those areas where it is likely to have most beneficial impact’.

It follows similar calls by Dr Nagpaul, who said the Government must ‘end the punitive overregulation that’s suffocating general practice - among the top four reasons why GPs want to leave the profession.’

He told the LMCs Conference last month: ‘We managed to get rid of the shameful intelligent monitoring bands, but still have practice ratings without context and circumstance, and which misleads the public with crude proxies that demean the holistic care hard working GPs provide.’

The blueprint also revealed that later this year the RCGP will publish ‘recommendations looking specifically at the patient safety implications of the rise in GP workload levels and the associated dangers presented by GP fatigue’.

Readers' comments (32)

  • If we remove QOF that is based on NICE guidelines, then GPs will follow their own NICE (Now I Can Experiment) guidelines when treating their patients.

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  • The problem is it will just be replaced by some other overly bureaucratic hoop jumping politically induced wheeze

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  • I don't hate QOF.

    I do hate the RCGP sticking their oar in contractual matters outside their remit.

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  • Knowledge is Porridge

    Clearly the government and NHS England want and need the 5Y forward view stuff to happen. I expect they will negotiate locally on QOF and the whole contract, trying to offer a carrot for innovation. Everything is up for negotiation.
    Unfortunately the appetite for change may be from those whom are struggling the most and need the help. They don't have the resources to stand still, let alone redesign the NHS on a local level.
    I think there is a really positive shift away from privatising parts of the NHS here, but new organisations, the PACS, MCPs are going to take some years to grow.

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  • Drachula

    QOF focussed the mind. The problem is 12 month target means you have only 10 months to do the work (realistically). Also, ridiculous demands by CCGs who are supposed to represent GPs. LESs and other contracts' paperwork take GPs away from the real work, and the need to prove the work is done.
    How do we find a sensible way of assessing excellence in GP? And, for that matter, teachers and other public sector workers. Suffocation by the tyranny of information.

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  • Although I blame the RCGP and academic general practice for introducing performance related pay in the first instance, this is at least a glimmer of light in the darkness. Now it is up to politicians to respond. The profession MUST stand united behind these moves.

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  • I think the RCGP and all of its sycophants should be scrapped.

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  • I do not do QOF the nurses do. Get rid of QOF, the work will continue iaw NICE guidance,and the idiots at DoH, RCGP, GPC etc will come up with plans that involve even more work to maintain practice income.

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  • The QoF money will go into extending hours only and inspection regime will be CQC monitoring the old QoF indicators so we can be beaten with a stick, the government will acheive both quality and quantity on the broken backs of General Practice staff and GPS

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  • again, this is just an exercise of pushing some Zeros ( money ) from one account to the other and
    the DoH lo longer liking/'liking any responsibility to do with it :

    once the sh*t hits the fan they'll be happy to skid in and out of it and thennn,,,,,,drumroooollll: blame GPs
    ...us lazy lot and looking to retire ?? before 65 --even some lucky ones aged 55
    the ( DoH and some colleagues) do not want to
    understand that , hmmmmm it's a job, a vocation a duty sometimes ( remember though : today's favour can be tomorrows duty ......) and when oh when are they likely to try and understand this ?
    SameDifDiffSh***t as the kids would say nowadays

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  • Just go back to peer clinical governance and professionally motivated practice teams
    Throw away all the qof trash that treats our job as piecework and recording often irrelevant figures bearing little relation to good practice
    And please please gpc can you lead professionally on the basis of primary care scientific evidence and not endlessly collude with the latest government non evidence based schemery by prostituting gps to do anything for a fee? No wonder morale is low and many gps move abroad where they can practise as independent ethical professionals
    GPC NO MORE PROSTITUTING OUR PROFESSION

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  • Qof with stupid rules that don't take into account the over burden of medicines for the elderly should be scrapped, but registers to get people in and seen still need to be there.

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  • Vinci Ho

    As I said in the past , people can only be united when share the same enemy and hence objective, not the other way round;share the same objective merely for the sake of 'unity'. Hope GPC and RCGP can see it more clearly now.........

    There are only two cases in which war is just: first, in order to resist the aggression of an enemy, and second, in order to help an ally who has been attacked.
    Montesquieu

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  • Vinci Ho

    You see :
    For you guys in GPC and Chaand , you were bullied every year by the politicians when it came to contract negotiations on the table . Even DDRB's recommendations were literally trashed .
    And you guys in RCGP , DC got himself and his party out of jail denying that there was a GP crisis by exploiting what your chair 'naively' said about the best time to be GPs, hence earning points before the election . Don't you feel like you have been 'used' by Darth Vader?
    Who is your common enemy????

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  • I stopped my RCGP subs a while ago because of a lack of knowledge of what goes on in real general practice.

    Getting rid of QoF actually helps private companies who never do well on QoF as they are run by locums or salaried.

    QoF is extra work but we are used to it and actually it does improve patient care.

    We will end up having to do all the work anyway but do a lot extra to earn that money elsewhere.

    The BMA and GPC tap themselves on their back for reducing QoF last year and this but work has not decreased but increased.

    Getting rid of QoF means you still have to do the work.

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  • If the QOF is removed, the funding will also go. We will be invited to earn that money back by taking on yet more work, however, we will still have to hit all the old QOF targets as they are "evidence-based quality indicators", and this will be monitored by CQC / NHSE / CCGs. End result - more work, same funding!

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  • keep QoF; Otherwise I can already see practices cutting short cuts, not arranging or chasing the patients for the reviews. Secondly if QoF is relevant: diabetes rev, CHD rev then noone will complaint.

    was it GPPAQ etc were the irritating bit.

    In fact asthma action plan which educates the pt on mgt of asthma should be introduced in QoF. Havent we all seen patients who dont have a peak flow meter, dont know their best PEFR and have no clue on what to do when they get an exac.

    Certain elements of QoF are vital.

    worst fear: locally arranged criteria will be worse, postcode element to it and we will still be monitored for the current qoF indicators (remember the Organisational Indicators)

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  • here is how it will work out ... RCGP will call for QOF to be scrapped - government will say no as the public wants a way to measure VFM. RCGP will cave in and government will create QOF + (a national QOF and the + bit is for local additions to QOF).

    IF the rcgp and bma started modelling what will happen to the nhs if GPs all went private then I think you will get more interest and support from government, media and public.

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  • There are many changes required to make General Practice attractive to General Practitioners.
    The most important one to tackle the cause of depression amongst GPs which led to suicides.
    GMC MPTS should scrutinise complaint against GPs before torturing them to distraction or resignation.They should not automatically take complaints before intensely scrutinising them. Summoning GPs from London to Manchester to attended torturing,with GPs often unrepresented by doctors lawyers,as informed by Prof Brian Jarman in his celebrated editorial ' BMJ 2012;245:8239'when Managers rule [patients may suffer and they're the ones who matter has raised issued clearly.
    Prof David Michael Hands challenge to investigate bullying in NHS in his letter to Editor should be urgently taken up to save NHS. GPs should be encouraged to whistle blow to bring up our health service standards
    GPs mostly take their work as a service for patients which should be rewarded not by torturing hem to resignation.
    The Law says Innocent until proved guilty.So the above necessary steps by GMC to prevent suicides and depression recorded amongst GPs.
    Resilience training should be forced on GMC MPTS not to take hurting unsubstantiated claims against GPs

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  • Eureka .Finally RCGP and GPC are waking up. I have been shouting along with grass root GP's that to improve GP working conditions and recruitment and retention it is essential that we have a seven point demands
    1. Scrap QOF
    2. Scrap CQC inspections to Primary Care
    3. Make Appraisals 3 yearly and revalidation 7 yearly
    4. the over interference of Nice
    5. Scrap NHS 111
    6.Reintroduce basic practice allowance to improve recruitment of partners instead of salaried and locums
    7. Restrict meetings for GPs by CCG etc to one per month and abolish prescribing ,referral,locality meetings and free GP's time to see I'll or perceived to be ill patients

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  • Peter Swinyard

    Well said Dr Devarakonda (10.58am). A wise programme to start to give us back our professionalism which will raise some headroom to treat patients and not spend our entire lives looking for the QOF prompts on the computer.
    QOF worked initially - our care of diabetics and hypertensives improved dramatically - but it has now become a box ticking exercise with targets subject to interference from the DoH/NHSE.
    The QOF money really needs to be moved lock stock and barrel into the global sum equivalent.
    I entirely agree on the basic practice allowance. There must be recognition of the extra responsibilities born by partners both clinically and organisationally.
    We also need real funding for premises improvements backed by recurring revenue funding - £1 of revenue funding creates at least £10 of investment in capital.

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  • Took Early Retirement

    What is this "new deal"? Is it the one it has been hinted should be made public by the SOS for Health in a week or so? If that is the case, I suspect the offer will be another bucket of faeces for GPs to eat, but the bucket will be a different colour.

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  • Samuel Lewis

    Leave US alone to do the job as we see fit.
    Pay US the full whack in the global sum.
    No strings, no checks, no cqc, no guidelines police.

    Really?

    Is that a squadron of flying pigs I see ?

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  • QOF has been successful over the years at driving the secondary prevention agenda of chronic disease usually provided by a well qualified nursing team. Workload is becoming unmanageable because of the short term theoretical additions to QOF and also LES' and DES' with ridiculous time frames. We need to plan for the longer term and take account of experience of what works and what doesnt.

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  • Peter Swinyard

    Without aiming for "flying pig" outcomes, we will make no progress as we will accept the status quo. I do not!!!!

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  • I am glad Peter Swinyard agrees with me and I got a great respect for his views in the past. It is time practice improvement grants are restored with the money saved from NHS111 and CQC and The gigantic bureaucracy of Appraisal organisation. We all know inspire of all the appraisals we still cannot stop psychotic GP's or nurses etc.

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  • Is it too much to ask The Legal and Medical professions should rise above the present penny counting methods that contributed to greed in Dr Harold Shipmans case.
    Aristotle in the olden days of lawyers predecessors the Sophists could make an innocent poor man guilty and a rich guilty man free by twisting words in the court of Law .This lead to institution of Aristotelian Logic Training.Our lawyers should rise above penny counting and think of Patient care provision as a whole.
    Both legal representatives of doctors and doctors themselves should rise above the present situation. Gps should refuse prescribing Evidence based harmful medication for patients,even at a personal cost to themselves.
    A prominent lawyer has told me we cannot expect justice in this world.This requires a revolution in thinking
    A Moral revolution is required in The UK.
    Throwing money to better patients care will only feed the greedy rich with no help for the patients

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  • I would rather dump Appraisal and Revalidation.
    Presumably the RCGP have not managed to find a way to make money from QOF.

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  • 1) Appraisal and revalidation has not found any significant faults with the overwhelming majority of GPs and yet it comes at a significant bureaucratic, financial and personal burden. Typical knee-jerk reaction that proved expensive and is proving pointless. Should go.
    2) QOF is like crack cocaine - you know it is bad but you want it anyway. It has not improved outcomes, has become a barrier to the doctor-patient relationship and has cost a considerable amount of money. Yes, it improved incomes but all it was was a bureaucratic load. It should go.
    3) CQC is equally pointless.
    The truth is that most GPs are interested in the best outcomes for their patients. Give them the appropriate guidelines and access to investigations and treatments and these will be applied. Measuring costs money. Whose need is it to measure? Restore the doctor-patient relationship where the focus is on the needs of the patient and you will find there will be happier and more enthusiastic GPs. What we do is not just what we do, it is who we are. Outside interferences that do not add to the relationship are burdens on the relationship and they should go. Money will be saved - and outcomes may actually improve. Not everybody is Harold Shipman or aspires to be him.

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  • In Somerset we have been without QOF for over a year. It has been a professionally liberating and enthusing experience.
    QOF may be evidence based, but the evidence base has had 10 years of potential manipulation. Combine that with interested parties lobbying for their QOF target, with political interference, and it is clear QOF has had its day.......especially in a cash strapped health economy.
    My experience has shown that scrapping QOF and refocusing on patient centred care is hugely more enjoyable and allows room for greater critical thinking......which leads to better management plans, demedicalisation when appropriate, and increased patient autonomy.....and thus reducing demand.
    If you get the chance I can recommend dropping QOF and refocusing to put hard work into making a sustainable service for our patients.
    (p.s. gp partner for a number of years now , not salaried as stated)

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  • Prior to QOF I observed under treatment of hypertension. Even my HCA expressed concern at certain GPs not interested in taking any action and at least 2 x GPs insisted on trying to stop me finding new diabetes.

    Post 2004 QOF I observe over treatment of hypertension. Certain GP's starting lifelong medication without allowing some patients a period of time to discount it is stress related. Many of these had normal blood pressures only the year before.

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  • Just had CQC help decide to close a surgery and a great bonus is a new block of flats soon

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