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Independents' Day

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)

  • 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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  • 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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