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Swine flu 'not severe enough' to suspend QOF

By Steve Nowottny

The Department of Health has changed the rules set out in its own pandemic plans so it no longer needs to suspend the QOF in areas hit hardest by swine flu, Pulse can reveal.

Ministers have abandoned the alert system developed for a flu pandemic because they say the virus is not sufficiently severe to warrant radical action, and are rebuffing desperate appeals by GP leaders to relieve pressure on practices.

The GPC has called for an immediate suspension of the QOF and other routine work in four cities – London, Birmingham, Glasgow and Sheffield – as GPs struggle to cope with hundreds of new cases.

As first revealed last Friday on pulsetoday.co.uk, GPC negotiators have repeatedly pressed the DH to declare UK alert level 3, which is supposed to be triggered when one or more outbreaks occur in the UK.

Level 3 would be the signal for GMC pandemic flu guidance to come into force and the QOF to be suspended, with GPs to be paid based on last year's performance.

But the DH has yet to use any UK alert levels, insisting ‘the majority of cases are not severe and we are not seeing sustained community transmission'.

A spokesperson appeared to rule out suspending the QOF in outbreak hotspots, saying: ‘If implemented, the pandemic flu statement of financial entitlements would apply to all practices in England, rather than specific areas.'

The clash comes amid mounting confusion over the best strategy to combat the outbreak. GPs in London and parts of Birmingham have now been told to use clinical assessment rather than laboratory testing to identify cases of swine flu, and issue prescriptions accordingly – even though the Scottish Government has abandoned that policy after finding clinical diagnosis was ‘not as effective as originally thought'.

Dr Peter Holden, GPC negotiator and the BMA's lead on pandemic flu, said: ‘We now have person-to-person trans-mission in clusters – that is alert level 3. That has serious implications for our contractual status, but ministers won't declare it.

‘GPs in the localities affected are under extreme pressure. We are able to cope, but we can't do the day job and the flu job.'

Dr John Ip, a GP in west Glasgow, said GPs were ‘extremely busy' swabbing patients and carrying out home visits: ‘It's time for discussion about suspending the QOF. There is a lot of anger – it seems national plans are not being used to benefit GPs.'

But Dr Maureen Baker, the RCGP's head of pandemic planning, said the Government should focus on reducing the flu burden on GPs rather than suspending the QOF: ‘The problem is swabbing, contact chasing, calling the HPU – these things are bogging down GPs.'

Practices in hotspots are too busy doing swabs and visits for routine work Practices in hotspots are too busy doing swabs and visits for routine work Best-laid plans?

The plan
• UK alert level 3 triggered by one or more UK outbreak
• GMC pandemic guidance comes into effect – asking doctors to be prepared to work ‘outside normal scope of practice' with provision for recalling retired GPs
• Routine work in primary and secondary care, including the QOF, to be suspended to ensure ‘maximum surge capacity is available'

In practice
• DH yet to declare any UK alert level, as most cases ‘not severe and we are not seeing sustained community transmission'
• GMC guidance and suspension of routine work have not come into effect
• DH has ruled out selective suspension of the QOF, saying the pandemic flu contractual arrangements ‘would apply to all practices'

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