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GPs go forth

GPs face loss of 50 QOF points under upper threshold changes

GP practices could see their QOF performance dip by an average of almost 60 points if planned hikes in the upper payment threshold for the QOF go ahead next year, say researchers.

Their study looked at practice performance under QOF in 2011/12 and measured the impact of matching the upper thresholds to the best performing 25% of practices.

They found that if performance remained the same, the increases in the upper payment threshold will see an average loss of 47.68 QOF points per practice.

But they found that many practices will have little change in income under the change - due to the increase in the value of a QOF point from £133.76 in 2011/12 to £156.92 in 2013/14 - but that practices will see increased workload.

The research, published in this month’s edition of the British Journal of General Practice, found the net impact would be ‘small’ on practice finances overall, with a mean loss of £279.60 per practice.

But the research was conducted before the Government announced that the changes to upper thresholds would be delayed until April 2015, and so the financial calculations are based on the exceptional increase in the value of QOF points in 2013/14.

The study concluded that although practices will not be greatly affected financially, threshold increases could take their toll on patient care as ‘unrealistically’ large workloads coupled with insufficient funding could result in practices ‘either deciding not to deploy resources to achieve these thresholds or to increase the use of exception reporting.’

Increasing QOF upper payment thresholds to the best performing 25% of practices will begin in 2015. The Department of Health said that the hike, which will see GPs working a lot harder for their QOF funding, would ensure patients benefited from ‘best practice’ and will save lives, a point the GPC have contested.

Researchers who wrote the BJGP paper claim that: ‘Payment for performance in health care is increasingly used to drive up performance. Although there is evidence that payment incentives increase the clinical management and outcomes of patients, there is an increasing body of evidence that demonstrates the unintended consequences of this approach with the increases in the rate of exception reporting being the most widely reported.’

The study looked at the 2011/12 QOF dataset that covers 8,123 GP practices and 55.5 million patients in England.

Please note: This story was updated at 10:24 on 22/01/14 to explain that the financial calculations in this study were based on the exceptional increase in the value of QOF points in 2013/14 and this may not apply in 2014/15.

Readers' comments (5)

  • The amount of effort can be so huge that the financial rewards are just not worth patient care suffers. Stupid targets with stupider outcomes for patients

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  • Sorry but this does not make sense average value of a QOF point in England in 2013/14 is £156.92 so the loss of 57.68 points is £9051 not £279.6 could pulse please clarify is it because the value has risen from £133 this year?

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  • Thank you for this comment - that is correct. The financial effects of the upper threshold changes were largely cancelled out by the rise in the value of a QOF point in 2013/14. We have updated the story to reflect that.

  • This is a test of practices' organisational skills, not clinical performance.

    A decent call-recall system and careful exception reporting is the key - call patients in one a month for December to February, then exception report those that don't come in during March.
    Carefully consider each patient to see whether the indicator is appropriate and patient unsuitable those where it is not (dying, contraindicated etc), with a patient specific note as to why.

    It's a lot of work but, as meerkats apparently say, simples.

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  • The price per point may have increased from £133.76 to £156.92, but the average size practice has also been changed and is now 6911 patients instead of 5891, reducing each practice's list size factor. Net effect, no increase in payments for QOF

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  • Unfortunately much of this paper is wrong due to the fairly basic misunderstanding that Anon 11:26 has pointed out.
    How this ever got through peer review I have no idea. Its conclusions are worthless.

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