This site is intended for health professionals only

At the heart of general practice since 1960

Major GP funding review to tackle variation in practice outcomes

NHS England is set to launch a major root-and-branch review of practice funding to see how it can introduce more ‘levers and incentives’ to ensure GPs are improving patient outcomes, Pulse has learnt.

The review will look at ‘the full spectrum’ of GP pay in England over the next couple of years, including which areas of practice funding should become subject to more performance measures.

In a move that the GPC has called ‘deeply concerning’, NHS England confirmed that they were reviewing QOF and all other sources of practice income as part of the review, to support the achievement of NICE-defined outcomes.

The move was first hinted at in an interview with NHS Medical Director Sir Bruce Keogh in the Guardian over the weekend where he said that NHS England was considering whether ‘differential payments could be used to tackle variation in the quality of care provided by GPs’.

In the same article he warned that CCGs would be encouraged to withhold payments from hospitals unless they could demonstrate they had met NICE quality standards.

It comes after the Department of Health ordered the NHS finance and competition regulator to launch a review into whether GPs are ‘operating in the best interest of patients’ and concerns about ‘a lack of choice’ of practices for patients.

A spokesperson said: ‘Outcomes are the new currency for the NHS and will increasingly be the focus of accountability at every level of the system. But, driving improved outcomes requires us to out in place the right, evidence-based processes of care.

‘That is why NHS England has commissioned NICE to develop a broad library of over 180 quality standards covering the main pathways of care. This is work in progress.’

‘Armed with these evidence based standards and an ability to measure the outcomes they are designed to deliver we will increasingly be looking to develop an aligned set of levers and incentives which work together, rather than against one another, to improve patient care.’

The spokesperson said they would be looking at how the NICE quality standards relating to aspects of primary care can be used ‘to incentivise GPs as providers’. When asked by Pulse which areas, the spokesperson said it would include QOF and all other areas.

‘Work is ongoing to explore the full spectrum of options,’ she said.

GPC deputy chair Dr Richard Vautrey said any action to withhold GP funding could have serious consequences for practices.

He said: ‘It is deeply concerning how little those in key roles in NHS England seem to understand about general practice. Proposals like this could potentially set in train changes that would significantly undermine our service that is so valued by patients.

‘These comments appear to be a surgeon’s simplistic understanding of general practice and completely fail to recognise the complexity of what GPs do.’

Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

You can find out more about how to protect your earnings at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers. Richard Apps, partner at RSM Tenon, will be presenting a session on how to maximise your practice income and keep an eye on your cash flow.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.

Readers' comments (15)

  • Young Doctors: advice from someone about to retire tomorrow having taken VER


    Unsuitable or offensive? Report this comment

  • further advice to medical students - DO NOT BECOME A GP!!

    Unsuitable or offensive? Report this comment

  • And yet more cr*p. I am losing the will to live let alone practice.

    Unsuitable or offensive? Report this comment

  • Is this the same chappie who closed the Leeds heart surgery unit the day after the court verdict went against the same. I rest my case. Outcomes are mostly based on social factors like deprivation which in turn leads lower quality outcomes even for standardised procedures.

    Unsuitable or offensive? Report this comment

  • Hmmm. I see a 95% confidence interval issue coming on. Large practices will be fine- excellent care will be evened out by poor care within the practice. Hard working single hander providing excellent care will get shafted by statistical chance.

    Unsuitable or offensive? Report this comment

  • The sad thing with the changes are that poor people will suffer. the inverse care law will become even more magnified. doctors that lose their practices in the inner city will simply find roles in more plusher areas or move into private practice/go to australia. The NHS does not feel safe.

    Unsuitable or offensive? Report this comment

  • Surely this is a good thing - there is an appalling variation in the standard of primary care performance, but with the exception of QOF the contract and payment systems treat the best and worst practices the same.

    Anything that reduces that variation without penalising the good practices or those with more challenging populations (earlier comment is right to highlight the inverse care law) can only be good.

    As ever the key is not what you do, but how you do it....

    Unsuitable or offensive? Report this comment

  • Anonymous | 05 April 2013 11:25am

    I can easily improve the outcome of every indicator in my surgery - Move the practice to wealthy well educated area, make it clear to non compliant patient they are not welcome, off list any difficult patient (and it's not difficult to find "valid" excuses to do so), start using non cost effective but more result effective medicine as first choice etc.

    But that's not what GP is about. I'm here to help patients include those that are non profitable from organizational sense. Do you really want to start looking at your patient and see them as profit generating goals? Because that's what private sector businesses do.......

    Unsuitable or offensive? Report this comment

  • Medicine is about making a difference.

    Our so called leaders have lost sight of the difference between making a difference Vs. achieving exactly the same level of outcome regardless of the tools we are given and the problems we have to overcome.

    Unsuitable or offensive? Report this comment

  • Anon 12.02 I don't understand - this is about adding in financial incentives that reward quality care. If the incentives are aligned correctly then there wouldn't be any reason to do any of what you list.

    There is however a variation in the performance of practices that is nothing to do with practice population, that is what would be tackled by this (if it's done right).

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page

Have your say