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GPs told to continue working on retired QOF indicators to 'demonstrate good patient care'

Exclusive GPs have been told by NHS managers that they are ‘required to’ continue providing services that were dropped from QOF as part of this year’s contract negotiations to demonstrate ‘ongoing delivery of good patient care’, a claim that has been rubbished by the GPC.

An email from the Health and Social Care Information Centre (HSCIC), distributed via NHS England local area teams to practices, said that practices had to agree to data relating to 24 retired indicators being extracted by 23 January to prove that they ‘continue to provide the services linked to these indicators’.

The indicators, which were scrapped for the 2014/15 GP contract, include a direction to use the criticised GPPAQ questionnaire to ascertain exercise levels in patients with hypertension, as well hypertension blood pressure targets that had been criticised for risking overtreatment of patients.

As part of the contract, NHS England said it would ‘continue to collect and publish data, as far as possible, on the relevant interventions and outcomes in order to support practices in promoting ongoing quality improvement’.

However, the GPC has strongly disputed that this would involve continuing to provide these services to the same extent, and has issued a warning note to all practices informing them that the email from HSCIS and and local area teams is inaccurate.

There is no indication about how NHS England will enforce this, but the GPC said there was an ‘anxiety’ that the data would be used to measure practice performance similar to the CQC’s ‘intelligent monitoring’ data and that it could be used by CCGs looking to implement their own local versions of QOF.

The note from HSCIC, sent to all GPs, said that the funding had been removed from QOF and put into the global sum, but the services still needed to be provided.

The document said: ‘The indicators included in this customer requirement were previously included and funded through QOF 2013/14. These indicators have been retired from QOF and payment has transferred to the core GMS contract for payment through the global sum.

‘It is a requirement for general practices to ensure they continue to provide the services linked to these indicators. This data extraction will help inform commissioners that general practices are continuing to do this, demonstrate their ongoing delivery of good patient care, and provide statistical information.’

However the GPC said that they had only agreed for the continued extraction of the data linked to the indicators, not for the practices to do the work.

In a warning note to practices, the GPC wrote: ‘GPC has heard a number of understandable concerns regarding recent communications from [HSCIC] about retired QOF indicators for 2014/15… HSCIC suggests that “it is a requirement for general practices to ensure they continue to provide the services linked to these indicators”. This statement is incorrect and is not what was agreed by GPC, NHS Employers and NHS England in the 2014/15 contract negotiations.’

It added that the GPC ‘anticipates a large fall in the recording of many of the retired codes’ as practices ‘now work more appropriately’.

GPC said it was especially concerned about the wording of the document in light of the CQC’s recent use of QOF performance and patient survey results to publicly band GP practices into ‘risk rating’ categories.

It wrote: ‘Following the wholly inappropriate and flawed use of coded data by the CQC as part of its “intelligent monitoring” risk assessment, practices are understandably anxious about how data that is extracted will be used.’

Dr Robert Morley, head of the GPC’s contracts and regulations subcommittee, said: ‘The document is from HSCIC and GPES but forwarded via area teams by NHS England. It directly contradicts the contract changes agreement and GPC is taking the matter up urgently with NHS England.

‘My hunch is that this probably represents cock-up rather than conspiracy but nevertheless suggests a deeply worrying lack if understanding by those who should know better of GP contractual obligations, clinical autonomy, the difference between essential services and QOF and the nature of the agreement that was reached.’

He added that there were implications around ‘how practice performance might be judged in future, for example by CQC. and the ‘increasing likelihood of local deals replacing QOF’.

He added: ‘We’ve already seen one disastrous example of this, of course, with the CQC “intelligent” monitoring debacle for those practices that had opted into a local QOF all being given a “high risk” ranking.’

HSCIC was approached for an explanation but said this was a matter for NHS England.

Pulse is still waiting for a clarification from NHS England.

The GPC negotiated wide-ranging changes to the QOF ahead of the 2014/15 contract, including the retirement of 24 indicators worth a total of 185 points from the clinical domain and 14 indicators worth 33 points from the public health domain.


Readers' comments (28)

  • I hope they are told to go forth and multiply off. time for a back bone from our GPC, the draw a line under this once and for all.

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  • No backbone there! They make a noise about it now and then in a few months time they'll suggest "well you may as well do it!" and then CQc will use the fact yoiu have not sent any data as evidence you do not provide patient services! You can see what is coming next in the language they are using now!

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  • is there anything stopping us from moving back to paper records?

    perhaps we keep the electronic record for major diagnoses, current medications and allergies?

    - anonymous salaried!

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  • I would urge colleague to enlist the support of their LMC if there are any concerns with this and NOT submit data

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  • already given up hope NI GP

    QOF was always a voluntary service.Practices chose to collect Data on certain Disease registers and were then paid acording to which targets they reached.Checks could then be made according to the grade of evidence required.Once moved into Global Sum Equivalent ALL reporting requirements were removed.Practices would continue to provide good clinical care and clinical governance assurrance as to their efforts to continue to do so.THERE ARE NO REPORTING REQUIREMENTS FOR RETIRED INDICATORS.As a side issue how could practices persue these indicators without appropriate search engines anyway?

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  • I know that the BMA have often spouted that GP morale has been low ever since I was a trainee 30 yrs ago. However, the recent vitiation of general practice in the past 6 yrs or so is something on a completely different scale. The new contract in 1990 forced GPs over 70 to retire because they were thought to be a liability. Now the NHS is struggling to retain the > 50 yr old GPs. It beggars belief. I have no doubt in my mind that if GPs were allowed to get on with the work that they wanted to do, then much of the low morale would lift

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  • not sure I can summon the energy to write B****cks - oh yes I can...

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  • Una Coales. Retired NHS GP.

    'I freed a thousand slaves I could have freed a thousand more if only they knew they were slaves.'

    Harriet Tubman

    As someone who grew up watching my mother suffer from domestic violence, I am trained to recognise the signs of chronic abuse. NHS state GPs are being abused! Wake up! You are in a catch 22. You cannot take the government to employment tribunal because you are 'independent contractors', yet you are not independent as the government keeps changing the terms and conditions of your contract and making it more and more exploitative. Even your pension is not untouchable and the terms can be changed as this is exempt from contractual law! Your chronic stress is because working terms are being changed willy nilly and you cannot work any harder and keep sane. And when you recognise you have no breaks for food, the loo, etc., you still live in denial that even your basic human rights are being denied. I don't want you to end in a coffin well before your appointed time!

    I had a Chinese friend at Hopkins who chose IT instead of medicine. She is now wed to a lawyer in SF and they bought a $2.35 million architectual wonderpiece 4BR house last year. No worried about QOF, GMC, CQC, NHSE, CCGs, etc. Once upon a time, doctors and surgeons were the ones who lived in grand houses, but only here in the UK have I seen a doctor live in a ground floor council flat, she bought with her hard earned NHS money. It beggars belief.

    You can still love medicine and care about people, but you have to love and respect yourself first. Please recognise the signs of slavery. The government enticed private GPs away to join the NHS in 1948 by paving the mouths of private doctors with gold, more gold than they could earn in the private sector. Then they piled on the work and kept piling on the work, until an entire generation forgot how to be independent private GPs and earn their own living. Now you live in fear of not knowing how to charge clients if you go private, so you stay put and suffer. Fear of financial poverty is for domestic violence wives who do not have a college education, you have more than that, you have MRCGP, an internationally recognised medical diploma.

    And when they say, but won't you get bored if you retire early? I have never met a bored retired GP. For me, I spend my time renovating my home and browsing the houzz interior design app. Love it. Believe me, wives who do not have to work, do yourself a favour and quit so you can be a good wife and mother if this job is killing you.

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  • Una Coales. Retired NHS GP.

    Sorry that's no worries about QOF, GMC, etc...

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  • Does anyone have any evidence that we are being paid in the global sum for the retired QOF points, for either GMS or PMS contract holders?
    It has proved impossible so far to get a yearly summary for what we should have been paid for our PMS contract in Hampshire for the 2013-14 year, and no budget forecast for the 2014-15 year has been forthcoming either.

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