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Independents' Day

QOF sidelined in obsession with access

By Steve Nowottny

GP's have accused the Government of sacrificing far reaching clinical improvements to the Quality and Outcomes Framework because of its obsession with improving access.

The outcry came as it emerged that neither the Government's proposed pay deal, nor the draconian contract changes it has warned it will impose on GPs if they reject it , will include any new clinical areas for the QOF.

Instead the Government's proposed deal would see 58.5 QOF points reallocated to reward access, while the threatened imposition would slash 135 points from GPs.

The decision is a severe blow to calls for several clinical changes to the QOF, backed by the GPC but rejected by NHS Employers.

Under the GPC's proposal, 38.5 QOF points from the organisation and holistic domains would have been reallocated to two new clinical areas, for osteoporosis and peripheral arterial disease, and a new indicator covering the treatment of heart failure.

The points would also have been distributed among existing indicators, including chronic kidney disease and ethnicity monitoring.

But Dr Richard Vautrey, GPC deputy chair, said: ‘Clinical indicators have been completely taken away from the table by the Government.'

‘They appear not to be interested in improving quality of care, they're purely interested in extended hours. That appears to be a priority above all else even though it doesn't help to improve quality for the most vulnerable patients.'

Dr Alun Cooper, chairman of the National Osteoporosis Society's Primary Care Forum and a GP in Crawley, West Sussex, said poor diagnosis of osteoporosis was a ‘national tragedy.'

‘The introduction of new clinical indicators for osteoporosis would have represented probably the most significant improvement in patient care for the elderly in recent years,' he said.

‘This will seriously undermine improved care services for older people.'

Dr Peter Stott, a GP in Tadworth in Surrey and a member of the National Osteoporosis Society, added: ‘The QOF was always intended for clinical matters. Some of the administrative things could quite easily be done away with to introduce osteoporosis and peripheral arterial disease.'

‘New clinical areas and access don't necessarily have to be linked. It doesn't have to be one or the other – but it so often is with Government negotiations.'

However a spokesperson for NHS Employers said that clinical changes to the QOF were always agreed as part of a wider negotiated package.

Health minister Ben Bradshaw insisted that extended opening hours were a real priority for a significant minority of patients.

‘This is a good proposal that will go a long way to delivering the more convenient opening hours the public wants,' he said.

Ben Bradshaw

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