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A faulty production line

Plans revealed to slash GPs' QOF earnings

By Lilian Anekwe

The proportion of earnings GPs are paid via the QOF would be cut by two thirds under recommendations prepared for the NHS by a former senior adviser to the Department of Health.

A document seen by Pulse reveals NHS managers are being urged to reduce the proportion of pay GPs earn from QOF work to just 10%, down from the current average level of a third.

Dr Philip Leech, formerly consultant adviser for primary care at the DH, cited unpublished US research indicating ‘incentive payments should amount to no more than 10% of pay'.

His presentation was delivered to PCT chief executives and NHS officials before the GPC and NHS Employers agreed a formula for next year's pay deal which reduced the proportion of pay through the QOF, and which could be a template for future reductions.

Dr Leech, now director of Primary Care Leads – a consultancy commissioned to provide professional advice to PCTs – recommended continuing to drive down QOF funding as one way of raising the cost-effectiveness of indicators.

He also advised reducing the number of reasons patients could be exception reported and raising achievement thresholds for key clinical indicators, so the QOF could be more easily used to judge the quality of practices.

‘Average achievement is already very high and the QOF is not a discriminator of quality,' he said.

The proposal to clamp down on exception reporting is echoed in evidence given by NICE to the Health Select Committee's inquiry into health inequalities.

Dr Matt Kearney, GP public health practitioner and member of the public health interventions advisory committee at NICE, said: ‘I think there would be an argument for looking at exception reporting. One way would be to limit the way exception reporting is used and encourage practices to be very cautious with it, as it can disadvantage vulnerable patients.'

Dr Chaand Nagpaul, GPC negotiator, said: 'At the time the contract was negotiated in 2004 there was a greater proportion of income put into the QOF than intended. If the money was transferred to the global sum that would a least allow GPs to get income in a more stable manner and not at the mercy of clinical fluctuations. So in theory there are advantages, as it would reduce practices reliance on MPIG. But it will be an issue of debate just how much it should be reduced without diminishing care.'

NHS chiefs are discussing plans to slash the value of the QOF NHS chiefs are discussing plans to slash the value of the QOF

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