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The QOF prevalence changes affect you – even if you think they don’t

NHS managers are trying to take advantage of the instability in GP funding to push through aggressive reforms across the whole of the profession

By Richard Hoey

NHS managers are trying to take advantage of the instability in GP funding to push through aggressive reforms across the whole of the profession

Not all GPs are terribly sympathetic about the losers under the changes to the QOF square root formula.

They point out that the QOF losers now have generally been the QOF winners over the last five years.

It's just ‘hard lines' in the words of one GP, but others go rather further.

One email to me suggested the losers under the prevalence rule change should simply be grateful they're not being asked to pay previous year's QOF earnings back.

GPs in areas of low prevalence are apparently morphing into the bankers of general practice, reviled for hoarding cash in the good years and resisting clawback when times get tough.

But if you're feeling just a touch hard-hearted towards your colleagues, here's some news for you.

The prevalence changes – and in particular, the sudden and destabilising way they have been implemented – will have a serious impact on every corner of general practice.

You don't have to take my word for it. Just read the attached briefing document for PCT managers which was on the NHS Primary Care Contracting website. We would have linked to it, only it has mysteriously been taken down. However, if you search for the title in Google you can still get the html version.

It calls the changes to the QOF formula ‘a start of a new era' for primary care.

And it makes clear, with a sense of palpable excitement, that this is a ‘real opportunity for PCTs', because NHS management has GPs exactly where it wants them.

Trusts are expected to take advantage of the financial vulnerability of QOF losers to pressure them to merge or accept APMS contracts.

And more generally, they are advised to use the financial uncertainty across general practice to drive an aggressive programme of reform.

The square root formula was deeply unfair and caused serious shortfalls in funding at many practices in deprived areas.

We first highlighted its flaws as long ago as August 2004.

But the Government is pushing through such abrupt reform of the system not in its eagerness to help under-funded practices, but through a desire to force general practice onto the back foot.

Pulse's campaign for a fair deal for QOF losers is important not only for the practices affected, but for the stability of the whole profession.

By Richard Hoey, Pulse deputy editor Briefing document for PCT managers on how to use QOF prevalence changes

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