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Independents' Day

Talks on scrapping QOF square root suspended

By Lilian Anekwe

Talks on scrapping the controversial square root funding formula have gone back to the drawing board, after the GPC backed away from plans to remove two key elements of the calculation.

In a letter to LMCs last week, the GPC admitted that in talks with NHS Employers it had discussed removing the 5% cut off and the square rooting calculation used to decide practice funding.

But negotiators said they had abandoned discussions for now because of concerns that a small number of practices would incur ‘significant losses' if they went ahead.

The news will come as a major blow to GPs in high-prevalence practices, who have argued the formula is systematically biased against them, and were hoping an alternative might be unveiled this April. It comes as a leading primary care academic calls in this week's Pulse for the formula to be scrapped or substantially revised.

The GPC has been in discussions with NHS Employers in a bid to remove the inequalities in QOF calculations. But they are now at a stalemate.

‘For many practices the change in calculation, whether up or down, would not have a major effect,' said the GPC letter. ‘There was, however, some concern that for a small minority of practices the change in calculation could result in significant losses.'

The NHS Information Centre has now been commissioned to compile a report showing the real financial impact of the factor across practices.

Dr Richard Vautrey, GPC deputy chair, told Pulse: ‘We are exploring this area but it's in its very early stages. Practices with very low or very high prevalences for conditions like heart disease or diabetes would lose out and that's something we need to be cognisant of. There would be difficulties in the transition.'

Professor Bruce Guthrie, professor of primary care medicine at the University of Dundee and a GP in West Lothian, writes in an opinion piece in Pulse this week that ‘the QOF is meant to reward work done, but the current payment system makes this link opaque and unfair'.

Professor Guthrie, who is due to resume his work as a GP shortly after a sabbatical in the US, wrote: 'Unfortunately, change will not be easy, because for every practice that gains from any change, there will be another that loses. But the current system is perverse and indefensible.'

Key criticisms

- Square root formula transformation - pays less per point to practices with high prevalence
- Truncation - intended to address extremes of prevalence but fails to protect small practices
- List size effect - large practices are paid more per point than small ones, even when prevalence is the same


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