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One GP in seven working under a local QOF

By Lilian Anekwe

One GPs in seven is already working under local QOF arrangements, with ministers now determined to make local frameworks a reality across the country, Pulse can reveal.

Our survey of 240 GPs found 14% were already working under a local QOF, despite fierce debate at national level about whether the Government's plans were appropriate.

Trusts in some areas are even introducing local targets at a practice level, with 11% of GPs saying their trust set them different clinical targets and priorities from neighbouring practices.

News of just how widespread local QOFs already are is likely to strengthen the Government's hand, with sources telling Pulse the question is no longer whether local QOFs should be introduced, but how great a proportion of the framework they should make up.

Department of Health insiders says ministers have made up their mind on local frameworks, but remain nervous of the charge that they will be responsible for ‘postcode lotteries' of care.

Local QOFs are likely to focus on areas of public health such as smoking cessation and obesity, where ministers believe they can most easily make the case for differences between areas.

Local QOFs are a hugely contentious issue, with both the GPC and the RCGP opposed to their introduction, but it appears the strength of opposition among grassroots GPs is not as strong.

Some 38% of survey respondents said they backed the Government's plans to introduce local QOFs, compared with 54% who were opposed.

More than a third of GPs backed the NHS Alliance's call for QOF indicators to be differentially weighted, to offer greater rewards to GPs working in deprived areas.

Dr Tim Heywood, a GP in Stourbridge, West Midlands, said: ‘There is little doubt in my mind that the QOF has been a good thing.

‘However, much of that quality is related to its effect on getting best population evidence into practice quickly. That would be almost completely destroyed by introducing local variability. I don't trust PCTs to set targets driven by health concerns.'

But Dr Una O'Callaghan, a GP in Colchester, Essex, called for NICE to oversee the setting of national and local targets.

‘If NICE is to supervise the QOF it also must supervise local direct and enhanced services as it is in this area that the most dubious and least evidence-based practice has been rewarded locally for our practice.'

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