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QOF audits to form part of 'value for money' drive in NHS

Exclusive Practice QOF points are to be the focus of a new cost-saving drive in the NHS after local area teams were instructed to stamp out fraud and ensure ‘value for money’.

Pulse has learnt that NHS England has changed the remit of the annual QOF audits that used to be carried out by PCTs to verify the performance of practices under the framework, and has linked them with the QIPP drive for greater efficiency in the NHS.

The body said that QOF audits will now have a new focus on ‘quality improvement’ and that the body had added the responsibility to ensure ‘contract compliance, value for money and eliminating fraud’.

The move comes despite a major report in 2011 exonerating GPs of ‘gaming’ the QOF, and after GPC concern that the changes to the framework this year would force an increase in exception reporting rates.

GP leaders have criticised the move, with one LMC saying that their LAT has already trebled the number of practices it intends to audit as part of its QIPP plan to maximise savings.

A spokesperson from NHS England told Pulse that they had changed the requirements on LATs to check QOF performance at GP practices.

He said: ‘Before April, primary care trusts were expected to conduct QOF visits to verify the income providers were claiming. The new focus is one of quality improvement - a responsibility shared between NHS England and the CCGs.

‘NHS England has an added responsibility to ensure contract compliance, value for money and eliminating fraud. This shift in emphasis from QOF verification to quality assurance is NHS England policy.’

He added that area teams were encouraged to conduct ‘random quality assurance visits’ and use GP practice performance information as a guide for when to make any follow up enquiries as part of their quality assurance responsibilities.

The development comes as it emerged that the Essex local area team will audit the QOF scores of three times as many practices this year, in a development that has concerned LMC leaders.

In a letter to local GPs seen by Pulse, Essex LMC chair Dr Brian Balmer said this ‘completely changes the context’ of the visits, with the audits no longer a ‘legitimate exercise’ but one to ‘prevent payments’ to GPs.

He added that last year only one out of 15 practices escaped the process without money being clawed back by the PCT.

The letter said: ‘The LMC has always supported reasonable actions by the NHS to audit payments to practices as part of its duty to safeguard public funds from potential fraud. As part of this co-operation, I have regularly drawn practices at random for QOF post-payment verification visits.

‘Guidance on a sensible number of practices is commonly accepted as being around 5%, but this year the Essex area team has decided unilaterally to arrange visits to 42 practices, which is 15% of the total. They have also said that this is not to audit against potential fraud, but that this is part of their QIPP (or money saving) plan.’

GPC chair Dr Chaand Nagpaul said he was not aware of other LATs increasing the number of QOF audits, but said they should not be lined with saving money. He said: ‘It is hard to understand how you can link QOF with QIPP. There is no clear link between the two.’



Readers' comments (10)

  • personally I think it has come too late
    the original proposal was to reinvest part of QOF earnings to improve care nut that has not happened in majority of surgeries
    how can one justify to attain full QOF points in single handed surgeries where there is not even a full time HCA let alone a nurse
    why should the GPs be paid for a register when it is absolute necessary to ascertain the prevalence
    yes QOF should have a string attached that the surgery should show how much they have invested in improving the care

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  • Why do the words value for money appear in quotation marks in the story headline?

    Is it a phrase that should never be used in the same sentence as QoF?

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  • QOF has become the epitome of 'mission creep'. There is something wrong when we're grilling ALL 74y old hypertensives about how much cycling they do. Useless target - no, not at all.....

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  • Take home profit per consultation here in NI is about £2.75 on average. The very best paid GP earns £ 4.25. That is good value for money. Really, it is high time that we followed dentists out of the NHS and charge them at the door or become like solicitors and contract out services per hour like legal aid. There is a huge amount of increasing work with the aging population and a worldwide shortage of doctors. We are already exceptional value for money. Why, oh why do we stay in this depressive, demeaning, demoralising and burn out NHS ? We do not need bouquets, but time to leave the brickbats.

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  • Apart from the huge increase in proper workload, there is this massive amount of managerial imposed paper work, ticking boxes, pathways, management plans etc in the middle of life/ death decisions. What an appalling state of affairs. As Copperfield pointed out we are so mired in ordure, we are becoming inured to this complete garbage. Help, help, GMC, BMA rescue the whole profession from burnout and depression.

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  • Yet some more naughty doctor police.

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  • I agree with 09.28, it's time to leave NHS work and follow the dentists route. This will free up resources to manage real illness rather than government targets.

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  • Remember that when QOF was first introduced many GPs were in favour of it.There was something very appealing about the idea of pay being linked to performance.But what these idealists didn't realise was that it was the thin edge of a very long wedge driven by the DoH to control and manipulate us.The end result is mass medicalisation of the population and precious resources wasted on chasing nonsensical targets.That is not what i signed up for when i became a doctor.We should not underestimate the effect of this intellectual demoralisation on the profession

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  • /Agree with 9.28. The amount of work we are expected to do is now beyond belief. Even the newer doctors do not want to work like this.Time for a complete change and become private and then see what the government will do!!!

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  • Value for money has to work both ways. If QOF is going to be linked to QIPP which is a euphemism for doing more for less, then practices need to make a decision as to whether it is still worth the while. Chasing meaningless targets to collect data for the NHS to sell on is not in my view a part of quality patient care.

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