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Gold, incentives and meh

QOF has reached the end of its useful life, says NHS chief

QOF has reached the end of its useful life, according to NHS chief executive Simon Stevens, who said that new GP contracts will phase it out.

Speaking at the Best Practice conference in Birmingham today, Mr Stevens said QOF had ‘delivered the gains it is going to produce’ and had now descended into box-ticking.

He suggested that new models will be trialled by GP organisations who are caring for patient populations of 30,000 plus and take on the new voluntary GP contract.

Mr Stevens said NHS England is currently working with a number of GPs 'on what an additional voluntary GP contract option would look like' adding: 'But a lot of people are saying this is a way of stepping out of and beyond QOF.

'My view is that QOF is now nearing the end of its useful life, it has produced those gains it is going to produce, and for the most part it has descended into too much of a box ticking exercise.'

But he stressed he does not envisage general practice going ‘cold turkey’ on QOF.

He said: 'We have to be thoughtful about how we do that, we can’t just go cold turkey on QOF from 1 April, but in the next 18 months we can use people like the members of the NAPC, to get it right.'

A model for the voluntary contract is due this autumn with the first versions set to roll out in April 2017.

Mr Stevens ended with his assessment of the state of general practice, quoting the Charles Dickens novel A Tale of Two Cities.

He said it was 'the worst of times, in the sense that the pressures have never been greater', but also the 'best of times, in that I do genuinely believe we are moving from denial, through the acknowledgement stage, through to the action stage nationally.’

In the same speech, Mr Stevens also announced that 300 practices are due to be handed funding from NHS England's premises and IT fund, and that 30 CCGs will receive funding to offer psychological therapy in GP practices to patients with long-term conditions.

GPC chair Dr Chaand Nagpaul said: 'We agree that QOF has reached the end of its useful lifespan, and it is good that Simon Stevens agrees with the BMA’s GPs committee as we have already called for the end of QOF in our Urgent Prescription for General Practice.

'This bold step, long overdue, will have a positive effect on practices by reducing bureaucracy and box-ticking, and allowing GPs to focus on the complex care needs of their patients.'

But he added that it was 'important that the phased removal and end of QOF should apply equally to all practices, regardless of their contractual status, and must not be used as a lever for movement away from the current contract to a voluntary local contract'.

He said: 'We believe that patients’ needs are best served under a national GP contract that provides nationally specified consistent standards of care.'

What is the new voluntary contract?

NHS England has said there will be three levels of sign-up to the 10-15-year contracts, which will allow practices to hold on to their GMS contracts alongside the new contract if they so wish, but will also give the option of becoming fully integrated into a 'multispecialty community provider' - which will provide secondary care services as well.

There will also be a watered down contract for practices working in an alliance to provide certain services.

NHS England has said the fully integrated model will include a 'gain/risk share' for acute activity, meaning that funding for the organisations will depend on reducing acute admissions.

The contract will also include a capitation element based on the size of its patient list, and a performance element to replace QOF - as already announced by then Prime Minister David Cameron - and the secondary care equivalent, CQUIN.

The GPC has warned that there were risks to practices signing a local time-limited contract.

Readers' comments (29)

  • NHSE, RCGP, CQC have long since reached the end of their useful lives also

    comrades if you dont yet realise who the mugs are.....its probably you

    ditch the country comrades!!!!

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  • Seems a shame to switch off the annual reviews and register based approaches that QOF has brought, they have had real benefits.

    Probably fair though that those are now the norm for most, sadly not all, practices.

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  • The end of QOF?
    Beware that it doesnt just mean that the income from QOF gets sliced off the income of hard-working practices... to fill the black hole of financial deficit.
    Whatever next? .. they will come for your Enhanced Service income.

    Then there will be no viability left in General Practice .. end of!

    Dont hold out any hope in the new model voluntary contract, there will be none there.

    Resources for General Practice to take part in Community Care projects in STPs? .. dont hold your breath

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  • It's not only end of QOF,it's the end of general practice! Alan Milburn's New GMS contract started it, Lansley's reforms Brought to the cliff , Simon Steven's STPs will push it! Thanks to BMA,RCGP.......General practice 'Jewel in the crown' is just reduced to ashes.....

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  • NHS Chief has reached the end of his useful life, says QOF.

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  • practices appointed extra staff to get qof points and money. if money goes then what happens to staff?. they just can't stop doing things to destablise practice finance. there is a bad news for practice finance every week. mpig goes, senority payment goes, pms practices deprived of funding, enhance serviced for tender. no wonder no one want to be gp partner any more.

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  • Hmm...history tells us that the work is likely to remain but the funding transferred to other work. In this way NHSE just keeps extracting more and more from practices. Don't expect the funding to be just transferred into the basic GMS contract.

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  • Should any reader wish to know the detail of this speech and the context in which it was made at the NAPC annual conference today, please contact
    Dr J P Kingsland
    President NAPC

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  • And you know what Simon?:
    It is a far far better rest I go to than I have ever known.

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  • Russell Thorpe

    One man and his dog, the sheep are in the pen and he pulls on the rope to swing the gate shut.

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  • Have a look at Chris Ham in HSJ. GPs will not give up their GMS contracts.
    Stand strong comrades, QoF goes then the work goes (back to hospital)

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  • This comment has been moderated

  • Don't worry chaps- the NAPC are advising. We must stay strong- just because management tell us something is going to happen doesn't make it true. Hold your CCG Exec to account for decisions they make on your behalf. You still have some power - don't waste it by think tanks telling everyone else what you think

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  • "in that I do genuinely believe we are moving from denial..." - well who exactly are these "we" who have been blatantly ignoring all the warning signs that have serially signalled General Practice being brought to its knees.
    You and who else Mr Stevens?

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  • I agree that QOF is getting to become a bit of a farce.
    However QOF has had some major benefits. Some people have short memories and forget how average some (not all) chronic disease management in primary care used to be.

    The question is why has it become a farce?

    It is because it is no longer being used for it's initial purpose. In recent years there has been a shift in the use of QOF
    - It used to be only for clearly, evidence based steps, but now has a lot more of a political whiff about it.
    - It used to set a standard that was achievable by practices when working diligently, but now NHSE seem convinced their purpose is to set targets that not everyone will achieve.
    - There used to be clear processes whereby patient autonomy was respected and the care for people who could be harmed by targets was safeguarded - but now practices get 'rated' on exception reporting.

    Abusing cost will lead to it's demise.

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  • This was a well balanced speech And optimistic in many respects, however it was not clear how funding is going to be rebalanced from secondary to primary care. CCGs were impeached to fight the fight to get the funding.
    Oh and Simon Stevens has a beard now so you need to update the picture!

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  • dont trust beardies, bowties or long hair.

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  • Clever idea to rob money off general practice.

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  • The targets will remain, just like the retired QOF indicators still have to be met for quality.

    The funding will be pulled.

    That's the name of this latest game.

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  • QOF was always a tick box exercise and whilst preventative care and improving patient outcomes has massive value, what happens to our income if QOF goes? What will it be replaced with? And what about patients?.....they now expect a 6 monthly or annual check up as a 'right', we'll be expected to continue with the CDM stuff, but a) not get paid for it and b) have to do something else as well to keep our income going........but hey, it's been a while since the goalposts were moved.....

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  • The CQC look at QOF performance targets as minimums not as aspirational targets for payment.

    So QOF payment goes, but if you stop the work - CQC will consider you inadequate.

    Never been a better time to be [something]

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  • What the Chief is trying to say that this pool of guaranteed income money is also going to be lost like the uplifts that have been lost by reducing Practice weightage numbers and moving funds from Primary care. It's happened with half the QoF money and seniority payments so why not go the whole hog and bury general practice.
    There is no transparency so nobody will find out where the 'saved' money went. Ideally,
    one would expect the government to release figures specifying the exact figures saved and where the money has been allocated but this has not happened.

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  • the nhs wrecker stevens is well beyond his useful life and his NHSE quango has proved to be a complete disaster with the fragmented chaotic NHS he bears considerable culpability for like brain dead nonsense such as personal health budgets.
    the same man who was a prime mover in the national disaster of the internal market which has wasted countless tens of billions diverted from patient care and wastes currently 5 to 10 billion a year for no proven benefit at all except worsening disjointed fragmentation
    please do patient care good by sacking much of NHSE staff and then RESIGN.

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  • I have researched incentive schemes in general and qof in particular.The useful ness of the QOF ended when consultants moved in offering their services to
    improve the performance and practices started recruiting them to improve the performance.The execution reporting is rife,goldbricking as it is known in the trade is prevalent and worst the practice performance is judged by CQC on basis of QOF achievement which has very little to do with outcomes.It is just the record of processes carried out.

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  • 5.35 you missed out one valuable organisation that you can add to your list.... the Great BMA

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  • The NAPC has now been rewarded for supporting the H&SC Act, 5YFV and STPs. Irrelevant to NAPC and Stevens that hundreds of practices are closing, that is what they want so that practices have to have 30,000 + patients, ripe for ACO and take over by private sector. Health Insurance anybody?

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  • i fully agree with simon stevens that QOF had its days-i have never supported QOF-the biggest joke is to pay for keeping a disease register which is the most important bit of LTC management- look at the National Statistics about Diabetes out comes-average 50%-there should not be any lower thresholds-one high threshold of 80% achievement and only then the payment should be done-the common statements that is heard is QOF is volutary well then the payments should be also voluntary

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  • Vinci Ho

    The most significant part of Dickens' quote was actually the end of the first paragraph at the opening of the book:
    'in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only.'
    Problem is we are losing middle ground politics and the 'best' and 'worst' are all existing for the sake of their arguments , Simon.

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  • The NHS is half wrecked. Ask any nurse or young doctor.
    These guys will wreck it like the rich gps who run ccgs

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  • There are some good reasons to phase out QOF. One is that it may be driving over-medicalisation in many cases, another that the level of workload is no longer supportable. we can only afford what is of highest value rather than of highest quality given the level of funding in today's NHS.

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