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At the heart of general practice since 1960

Quantum leap needed to be top quality

By Ian Cameron

GPs involved in a prototype of the quality and outcomes framework believe most practices will have to make 'a quantum leap' to score high marks in the first year of the contract.

The warning by members of the Primary Care Clinical Effectiveness (PRICCE) project in Kent came after a Pulse survey found practices across the UK routinely aiming near to the maximum 1,050 points.

The figures led the NHS Confederation to accuse GPs of 'pump-priming' to maximise their quality aspiration payments. Some trusts also vowed to challenge 'unrealistic' aspirations.

Dr John Heather, chair of the steering group of the PRICCE project and a GP in Cliftonville, said most practices had taken two years to reach high levels. 'Where a practice has no history in engaging with a quality agenda it would be difficult to imagine you could aspire to 1,000 points just like that,' he said.

'You would have to have completely rejigged your skill mix and redesignated administrative staff, employed more nurses and have project managers overseeing it giving real clinical leadership. I think it's more challenging than people have realised, though money is a big motivator.'

But practices that have aspired to high levels denied they were doing it to improve cash-flow and insisted they were being realistic.

Dr Rudolf Mercer, secretary of Suffolk LMC, which includes Central Suffolk PCT where 11 out of 12 practices have aspired to 1,050 points, said they were not 'gaming' the system.

'The standard of practices is high and a lot of practices are going to get very close to maximum points,' he said. 'They are not going from ground

zero as they have been computerised for years.'

Dr Simon Rudland, a GP in Stowmarket, Suffolk, said GPs at the practice had been doing much of the work that would earn them quality points but had not been recording data properly until now.

'Since the inception of the new contract we have been very proactive, looking at templates, data quality and altering systems to ensure we are in a position to maximise what's on offer,' he said.

'We found patients had been reviewed but we just hadn't put the right Read

code in.'

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