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Gold, incentives and meh

Nearly half of GPs think it is time to get rid of the QOF

Exclusive Almost half of GPs want to see the QOF completely scrapped, with some labelling the paid-for-performance scheme 'toxic' and 'onerous', a Pulse survey has revealed.

The survey of 750 GPs showed 46% of GPs want rid of the scheme in its entirety, while 34% said they would not, and 20% did not know.

GPs who wanted the QOF abolished commented that they would prefer the money to be put into the global sum.

Among those who wished to keep it, the survey revealed concerns about what would happen to the funding if the framework went.

Fears included the QOF being replaced by an even more onerous alternative, or the funding being lost entirely to practices.

And Pulse can reveal that GP feelings on the QOF have grown colder in the past five years.

The last time Pulse surveyed GPs on scrapping QOF - in 2013 - 47% wanted to keep it, 37% scrap it and 16% didn't know.

At the time, 70% of GPs said they believed clinical areas outside the QOF would get neglected as a result of it being ditched.

NHS England chief executive Simon Stevens said in 2016 that the QOF is 'at the end of its useful life' and health secretary Jeremy Hunt said way back in 2014 that he would like to scrap all of QOF's indicators.

But BMA GP Committee chair Dr Richard Vautrey told Pulse last year that the aim of their negotiations would be for the QOF to be 'retained but reformed'.

Although the 2018/19 GP contract is not yet announced, information provided at the GPC roadshows said there would be no changes to the QOF - but that a review for 2019/20 is under way.

Southampton GP Dr Peter Goodall, who wants the QOF scrapped, said: ‘I believe that the original reasons for starting QOF and allocating points were good but it has been eroded over time and often used as a tick-box exercise for political reasons.

‘A lot of the things that we did and got paid for have been subsumed into everyday practice and increased our workload. I think it would be fair for the money to be put into the global sum and reward everyone for what we have achieved over the last 14 years since QOF started.'

Leicester GP Dr Grant Ingrams said: 'I was a proponent of QOF and thought that at the beginning it promoted and supported improved quality of care.

'However due to increasing workload it has now become a bureaucratic burden to be endured for the money. QOF pays for the recording of data in a particular way rather than quality per se.'

A GP locum in Chester and Merseyside, who was on the fence about scrapping the QOF, said it had 'improved quality of care' but was 'far too onerous’.

A GP partner in Somerset, who wanted the scheme gone, added: ‘But I would be worried they would come up with a new onerous scheme.'

A GP locum in Dorset was more certain, suggesting the QOF was 'the most toxic thing currently in the NHS'.

GPC clinical and prescribing policy lead Dr Andrew Green said: ‘As was agreed in last year’s contract negotiation, we are engaging with NHS England along with other interested parties to look at whether changes in the QOF should be made to ensure that it remains relevant to modern general practice, particularly with regard to the challenges in providing care that is individualised to the patient’s needs’.

NHS England said: 'This is a tiny and self-selecting survey which lacks statistical credibility.'

An NHS England-commissioned study, published in September, 'found no convincing evidence' that the QOF had led to improvements in the treatment of long-term conditions. It recommended NHS England finds 'other ways' to motivate GPs to improve care.

Scotland has scrapped the QOF as part of the move to its new contract, however GPC Wales has indicated that the framework is likely to remain in the new Welsh contract that is currently being negotiated.

In England, the erosion of the QOF began with co-commissioning, with CCGs taking on general practice responsibility allowed to replace the incentives without explicit permission since 2014.

Would you like to see QOF scrapped in its entirety?

Yes - 45.9%

No - 34.4%

Don't know - 19.7%

The survey was launched on 10 October 2017, collating responses using the SurveyMonkey tool. The 25 questions asked covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to our readers via our website and email newsletter, with a prize draw for a Ninja Coffee Bar as an incentive to complete the survey. A total of 750 GPs answered this question.

 

Readers' comments (20)

  • QoF favours large Practices. If a single handed GP has 2000 patients, he or she gets almost 0.35 of the money for every QoF point achieved. A large 'standard' Practice with 3-4 GPs ie around 7500 patients, gets the full money for that same QoF point.
    The workload on the singlehanded is of 2000 patients and the workload on one GP in a large Practice is also around 2000 patients.
    So why this discrimination? QoF must go.
    It's not just educating people and making them realize that it is their responsibility to remember and go for checks instead of babysitting GPs who case and chide them to come in every year. People want control of their lives and they should be left to do exactly that. We do remember the elderly and the vulnerable and even without QoF we would certainly look after them - at least majority of us would.
    It was nuts who made the system and modelled it to their needs as bigger Practices.
    Lessons are never learnt and people not held accountable for manipulation. QoF is a glaring example of that malverse practice. It has to go - we know it - but it's not going because of vested interests within the GP Community and that talk of GPs losing money which will go elsewhere is very convenient to maintain the status quo.

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  • elsewhere senior doctors admit pension cap a factor in increased retirement rates noted by the accountants at a tax conference in 2012

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  • Unscepted - so on that argument a practice of 7500 patients should get 7500/2000 * 0.35 = 1.3 per QOF point as it is funding the whole practice

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  • When is the 2018/19 contract going to be announced? Aren’t we getting a bit close to April?

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  • already given up hope NI GP

    The problem with scrapping any part of QOF is where the re distributed money gets lodged.Usually it goes into Global sum equivalent not Global sum and this penalises small practices and could destabilise many

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  • Anyway one reason that the government introduced QOF was that it wanted proof GPs were working hard enough to merit their salary and weren’t down at the golf course every minute of the day (not that I play golf). QOF now seems outdated with all the other expectations imposed on us by both patients and beaurocracy. How our salary would be maintained if and when QOF goes is quite another matter although Scotland has ditched QOF but at the expense of rural practices being disadvantaged. Time for a revolution?

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  • They usually announce it the week before give you a contract like War and Peace and expect it to be signed straight away, a very dodgy way to do business one feels.Question is do you trust the government or the BMA,sadly I dont.

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  • My understanding is that any movement of QoF money into global sum creates winners and losers as it is done by redistributing a fixed QoF pot of money, so be careful what you wish for. May be the devil you know...

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  • @ Beaker: No, the other way round. Every Practice should be paid for a full QoF point. Let's take rural Practices with only 800 patients - do they not deserve the full point payment if they only have that many patients in a remote area?

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  • @ Really- NHSE will send the Contract once the 2018/19 financial year has begun - that is usual practice in our area of Kent and then you have minus 2 days to sign :)

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  • Dr Get-real: Since when is QoF money included in Global sum???? Aspiration is added to the Global sum but not part of it. Maybe in this NHS pudding it is being added in some areas, I wouldn't be surprised.

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  • I like QOF. It is proof that primary care is managing chronic disease.

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  • David Banner

    I think it is naive to assume QOF money will be diverted to the Global Sum. It will go the same way as seniority (I.e disappear), or worse be “reinvested “ in some horrendous new work stream. Losing QOF means losing the money, can we really afford this?

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  • QoF is a series of outcome measures and needs be retained. Dont forget if it gets moved into GS we will be told you need do the work still

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  • NHS Digital says average Practices are getting £152 per patient, there are Practices getting only 96 to 100£ per patient including QoF and notional rent. Will these Practices lose anything? I doubt it - you can't sink lower than the bottom of quicksand.

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  • Without even looking very hard there are three things I would get rid of - the massive fuss made over primary prevention of ischaemic heart disease with statins, and the huge waste of money that entails, the almost paranoid behaviour about mild to moderate hypertension, how little benefit treating it brings and how much harm the side effects cause, including the worsening of that non disease, ckd, usually in the elderly. Then the sweetener - we are encouraged to do polypharmacy reviews in the elderly to undo some of the harm the unnecessary QOF did in the first place!

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  • I would be very worried about losing an income stream which is tangible and you know what you have done, and what you have earned.
    The only reason the government would want to scrap QOF, is to :
    1. Increase workload for GPs for the same amount of money
    2. The full QOF money will never be reinvested into global sum- govt will take a large slice of it, and thus force practices into mergers/ takeovers by hospitals and MCPs, to be able to survive
    3. Both- this is where my money is, this is what i think their agenda is.

    Also, once QOF is scrapped, what are you going to do with your nurses/ HCA- sack them !!
    Be very careful of what you wish for !!.

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  • Just Your Average Joe

    Yes QOF is burdensome in its data requirement.

    However I know if it wasn't there, the quality of care for most patients would nose dive, as the requirements and pop up boxes remind all staff to do the right things for patients, and I know some colleagues wouldn't know/remember to do them and patients would suffer otherwise.

    Yes it is the kind of things GPs did before QOF but its implementation was hit and miss, now it is better.

    Cinderella areas where there is no clear QOF requirements suffer. How many people follow NICE guidance in testing and treating non QOF conditions? Guarantee you it would not be 90% type levels that QOF often requires.

    It is also great for new doctors and trainees and allied staff who may lack the knowledge of the requirements, and the prompts help improve care.

    Yes it is a pain to hit the targets, esp when adverse conditions in the NHS and wider environment cause chaos, but it does help patients, its funding streams pay for nurses and HCAs, and should stay.

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  • medicine tastes awful

    IN this business the list is simply growing.
    get rid of QOF
    get rid of the GMC
    get rid of Mr Hunt
    get rid of CQC
    get rid of 10min appt etc etc
    the list can only expand. if this does not work - best 2 get rid of yourself and leave the NHS.

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  • Good!
    What may have started off with good intent was soon hijacked and diluted by the political elite set on making statements to pressure groups rather than concentrating on valid outcomes. it has over time by promoting tick box medicine distorted the clinical values it was supposed to improve

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