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QOF overhaul set to ramp up workload

Ministers are planning a dramatic overhaul of the quality and outcomes framework that would ramp up GP workload by clearing space for a series of new clinical conditions.

The Department of Health is drawing up proposals to radically streamline the cardiovascular indicators in the QOF to squeeze in new targets and combat concerns over double counting.

Under the plans, a number of separate cardiovascular indicators would be merged into one, avoiding paying GPs more than once for patients on multiple CVD registers.

The proposals were first suggested to the department in an advisory report exclusively revealed by Pulse in February.

A source close to the QOF review told Pulse that points that were saved would be used to introduce new disease areas, such as osteoporosis, or new indicators such as long-term follow-up of stroke.

The source told Pulse: 'They are looking within the Department of Health at merging a lot of the clinical indicators.

'At present if you have a patient with hypertension, diabetes and ischaemic heart disease, those points count three times. But they see that as easy points, or points duplication.'

Professor Martin Roland, director of the National Primary Care Research and Development Centre, said the changes would be perfectly feasible and very easy to implement.

'The Government has concerns GPs are being paid twice. There's a big overlap between some of these conditions. The QOF can¹t get bigger and bigger so things that are there more than once have to come out.'

Dr Helen Hosker, a GPSI in elderly people's care in Manchester who was consulted on the review, said: 'It might give them the opportunity to offer entirely different QOF areas, because there are other diseases that people want to see in the QOF that are not currently there.'

Professor Julia Hippisley-Cox, who prepared the report for the department earlier in the year highlighting the overlap between QOF registers, told Pulse the proposals would be a 'good way forward'.

Professor Hippisley-Cox, professor of general practice at the University of Nottingham and a GP in the city, said: 'The nice thing for patient care is that if the patient has diabetes and hypertension, if that patient had one target that means we can align targets to individuals.'

But Dr Ahmet Fuat, a GP in Darlington, County Durham, and deputy chair of the Primary Care Cardiovascular Society, warned the changes could create extra work for GPs. 'Cynically speaking, it's a way of making us work more and paying us less. If they cut back payments then as a business we will have to look at cutting back.'

plan to combat double counting How ministers plan to combat double counting

Conditions such as diabetes, hypertension, left ventricular heart failure, stroke and coronary heart disease would be merged into one indicator, for metabolic disease

Streamlining inefficient areas of the QOF could release points to fund the inclusion of other clinical domains, including osteoporosis

Reducing double counting might also make space for new cardiovascular indicators, such as long-term follow-up of stroke

Dr Helen Hosker: changes will offer opportunity for areas not currently in the QOF Dr Helen Hosker: changes will offer opportunity for areas not currently in the QOF

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