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Local scheme to replace the QOF 'a success'

GP leaders involved in a local quality scheme held up by NHS managers as a potential replacement for QOF across the country have said that the scheme has maintained high quality of patient care while ditching reporting.

LMC leaders said the Somerset Practice Quality Scheme (SPQS), run by NHS Somerset CCG, looked likely to continue after ‘reassuring’ provisional findings from an independent evaluation of the scheme and the impact on general practice.

The final evaluation has been widely anticipated after NHS England told CCGs that they could ditch QOF as part of co-commissioning, based on the Somerset model, which allowed practices to drop reporting in all but a small set of core clinical QOF indicators when introduced last year.

Pulse revealed that a number of other CCGs were planning to ditch QOF as a result.

Commissioning leaders heading up NHS England’s co-commissioning drive indicated that CCGs would likely wait until a review of the success of the Somerset model are published, which is due for July this year, although some CCGs said they would be looking to start local incentives schemes earlier than this.

The LMC says that initial findings of the evaluation by the South West Academic Health Science Network suggest the scheme has been a success, and that the ‘key concern of stakeholders’ - that the quality of clinical care may decline - has not come to pass.

Somerset LMC minutes state: ‘We are now at the stage of the year where those who are signed up are viewed with envy by those who have not and are dealing with the QOF lists coming through with a vengeance.

‘There seems to be a growing national view that the value of QOF as it stands is in doubt and we anticipate SPQS will continue at least in to 2015/16. Early indications show that already we can demonstrate that quality of general practices in managing conditions in areas that really matter to patients has not been sacrificed by the implementation of the SPQS.’

The Somerset scheme got off to a delayed start last June, with 55 out of the 75 GP practices in the area eventually joining the scheme.

Participating practices have dropped reporting of all but a small set of ‘core clinical’ QOF indicators in place of delivering regular reports to the area team on how the released funding has been used to improve local services in three key areas, namely integration of general practice with urgent care service, improved personalised care and building practice sustainability.

NHS England advisers held up the scheme as an example that other CCGs can follow when taking on co-commissioning responsibilities.

Dr Amanda Doyle, co-chair of NHS Clinical Commissioners and NHS England’s adviser on the Next steps towards primary care co-commissioning guidance document, told Pulse last year that CCGs should ‘evaluate the Somerset pilot and roll out any learning from that’ before implementing their own QOF schemes.

Dr Harry Yoxall, medical director at Somerset LMC, told Pulse early signs indicated that the quality of care had not suffered as a result of dropping QOF.

He said: ‘The Academic Health Science Network for the South-West, which is looking into ensuring that quality of care has not been impaired by SPQS, has produced some very early tentative suggestions that the quality of care has been maintained.   

‘It hasn’t been running long enough to state anything categorical, but we were reassured that the quality of care taken as a whole hadn’t collapsed in the SPQS practices.’

 Dr Yoxall added: ‘The area team, the CCG, and the LMC have been reassured that there is still interest among practices, and that the information we have suggest it is worth continuing with the experiment.’

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Readers' comments (8)

  • Vinci Ho

    Very interesting

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  • If pharma announced a drug 'success' before the trial evidence had been published we would all be up in arms.

    Lets just wait and see Pulse

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  • Opting for a 'local' QoF is very dangerous. There is no national protection and it might be ok for the first few years but as always it will be made much more difficult. At a national level there would still be more negotiation.

    We have clinical commissioning at the moment, but alot of CCg leaders are secondary care focussed.

    It is a matter of time before the next reorganisation and when you have the old PCT back, the only way is doen

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  • QOF not only made GP partners become aware of latest guidelines but it also forced them to ensure that they adhere to these guidelines. We need not be surprised if QOF is reintroduced fairly soon because every GP will soon start implementing their own NICE (Now I Can Experiment) guidelines in managing patients and thereby compromising the quality of care provided to patients.

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  • I have little faith in the GPC's ability to negotiate decent terms for QOF, enhanced services etc, but that that is infinitely more faith than I have in our LMC's ability.
    In other words, from many years of experience, I have exactly zero faith in our LMC. It is always too willing to see the authority's side. I would not trust it one inch to negotiate decent terms for replacements for QOF. ESs etc.

    Remember, divide and rule. How stupid of GPs to rush to help NHSE divide them up.

    Keep it national.

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  • The most lucrative contracts could be going to Practices with representatives in LMC and CCGs who therefore can't be bothered to take on NHSE. Wouldn't trust local solutions - at least, at the national level, you can't have that degree of corruption.

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  • Now the CCG has to employ additional staff to formulate local guidelines and to set targets; then the CCG has to conduct educational sessions to their local GPs to inform them about that years targets and why they have been chosen; then the CCG has to commission another agency to design templates that could be used in the electronic systems (in a CCG has surgeries that use different systems like EMIS, System One, Vision, etc - templates have to be designed for each of these systems); then CCG has to employ someone to address any issues arising from the use of templates. So the CCGs might decide to have their own targets which when once agreed, would probably run for 5yrs in a row by which time local priorities may have even changed or the targets may have lost their evidence of effectiveness.

    Very interesting future for General Practice indeed.

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  • Samuel Lewis

    "some very early tentative suggestions that the quality of care has been maintained" ?

    or money for old rope.

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