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Gold, incentives and meh

Practices could ditch QOF to offer longer appointment times under draft CCG plans

Exclusive GPs could be rewarded for providing longer appointments for patients with certain conditions under plans being drawn up by CCGs to replace the QOF, Pulse has learned.

Commissioners are also looking at potentially merging incentive schemes for primary and secondary care to help integrate care.

It comes as NHS England has given the green light for CCGs to develop their own incentives schemes to replace the QOF locally under plans for CCGs to take responsibility for the commissioning of primary care.

NHS Somerset CCG has already introduced its own incentives scheme, which rewards practices for forming federations that share patient records and open up their books to the CCG and area team to ensure that they are financially sustainable over the next five years.

But plans being considered by other CCGs go even further, Pulse has learned.

Speaking at the Commissioning Live conference in Manchester yesterday, Dr Sarah Schofield, chair of West Hampshire CCG, told Pulse that the CCG was looking into developing its own incentives scheme, if it is given approval to take on the highest level of commissioning responsibility.

She said: ‘We started by asking our GPs and our members what they thought of QOF currently and asked them about the areas they would want to see improved – such as being able to bunch QOF into a series of long-term conditions type work would perhaps give opportunities to develop what seems beneficial locally.

‘For example, what we might be interested in saying is, for all our long-term conditions, practices need to have half-hour appointments with patients with specific long-term conditions, and they would have to do that, say, three or four times a year.’

She also said that merging primary and secondary care incentives ‘is one of the ideas being talked about’.

‘If you want to pull it closer to communities and patients, it seems nonsense to me to separate rewards into a primary and secondary rewards system. You really want to embed the two together, for the patients to get the benefits.’

Dr Schofield said that the CCG ‘hasn’t got anything off the ground as yet’ as it awaits NHS England’s approval, but added ‘these are the sorts of discussions we are having’.

Dr Graham Jackson, clinical chair at NHS Aylesbury Vale CCG and a member of the group that developed the co-commissioning plans, said that details about CCGs replacing QOF were ‘a bit vague’ which was ‘on purpose’, while waiting for CCGs to put plans together.

However, he added that there would be opportunities to bundle incentives together.

He said: ‘If you take, for example, your diabetes QOF, your heart disease QOF, and other related issues, you could quite easily create an outcomes framework that talks about the improved health and wellbeing, and improvement in MIs down the line.’

Joseph Chandy, director of primary care, partnerships and engagement, NHS Durham Dales, Easington and Sedgefield CCG, said that concerns over conflicts of interest in GPs developing local incentives schemes were misplaced.

He said: ‘The perception of scrapping QOF and GPs lining their own pockets, I think a lot of areas demonstrate the opposite, and a lot of our clinicians feel that QOF on say COPD or diabetes does not go far enough now. It doesn’t include everything that NICE recommends.

‘Many CCGs have laid on top of QOF local incentive schemes and put further money in to raise the bar even higher. So the ability – if we are given the autonomy – to reconstruct QOF and include those higher NICE requirements means we could even be paying GPs less money.’

Readers' comments (7)

  • Vinci Ho

    The argument of whether GPs should be generalist or with some special skills remains all the time. Money and time are our tools. If NICE or more importantly ,a government with common sense , wants more chronic diseases to be managed more properly, GPs need to have genuine support from specialists to upskilling in community. Of course, not all GPs should give up their role of a generalist........

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  • We should ditch average list sizes now and get paid on a pay per appointment system. If we do not, required appts will explode. Dementia and diabetes are due to double in 10 years, never mind the silver tsunami of multi-morbidity We will do all this extra work for free in average list size.

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  • They may talk about giving up QoF, but it is clear that CQC will use these measurements as part of their "assessment" so it will still need to be done. Add longer appointments if you like and have the time, but don't pretend that this is instead of QoF.

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  • Have the local GPs agreed to any of this?

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  • So, can someone tell me what components of clinical care and review surgeries are going to stop performing if QoF payments are dropped? Most would be included in NICE guidance and are now generally accepted as appropriate standards of care - stop doing them and be damned. Allowing your CCG to come up with new schemes and dropping QoF will just result in additional work for no additional resources. Remember CCGs are membership organisations, agitate for a vote of no confidence and get rid of the GPs supporting such changes.

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  • Could we please ditch both ~QoF and the long working hours ?

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  • The NHS is based on universality applied to clinical need. The Gadarene rush to fragment every locality with flat pack coffin building schemes is doing the politicians' work. CONmissioning does not manage a single patient.
    If the public vote for private USA care there may be a case for altering to a privatised version of health care. The dismal loss of professionalism and clinical.leadership is resulting in this descent to chaos.
    Political cycles are short but enormous damage can occur in 5-10 years. Be careful what you wish for.

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