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A faulty production line

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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