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QOF may shrink to '3-4%' of GP practice income as review ‘nears completion’

Exclusive The QOF in England looks set to be retained, but could be slashed back to just 3-4% of practice income, according to a GP member of the review group.

RCGP vice chair Professor Martin Marshall told Pulse that rather than a current 8-10% of practice income, the QOF should be stripped back to a ‘much smaller set of indicators’, under plans that are being pushed by the RCGP.

The interview followed a speech at the Londonwide LMCs Conference today, in which Professor Marshall said the QOF was 'unlikely' to be scrapped entirely by NHS England as the review group's work was 'coming to an end'.

The remainder of the funding could be ploughed into a national ‘quality improvement programme’, that would allow GPs to choose from a ‘menu’ of other services - such as for example obesity services - for which they would get paid, Professor Marshall said.

‘It’s very unlikely that England will just abolish it and leave a vacuum in the way Scotland did,' he told the conference - adding that this was ‘a much more sensible way of taking the system forward if GPs are willing to take the shake-up in the system that that would require’.

Explaining the proposals to Pulse, he added: 'If we cut QOF down to a much smaller set of indicators - maybe only 3% or 4% of practice income - then the rest goes into a quality improvement programme, the quality improvement programme would essentially be a menu that practices could choose from.'

He said that this would allow practices to chose what services they want to offer from obesity to health inequality.

'There will be a range of perhaps 10-15 programmes and you might chose one or two a year, and then you get paid a sum of money just for doing that,' he said.

The changes to the QOF were due to come in from this year but have been subject to significant delays. According to Professor Marshall, the changes will now be subject to 2019/20 GP contract negotiations and a consultation with the profession.

The news comes despite health secretary Jeremy Hunt expressing a wish to get rid of the payment-per-performance scheme, and as NHS England's chief said it had reached the 'end of its useful life'.

Professor Marshall said the new system would be 'a high-trust, profession-led, quality improvement scheme rather than a low-trust, government-led quality assurance scheme'.

He said the RCGP, which sits on the QOF committee alongside the BMA's GP Committee, NHS England and other stakeholders, had pushed for the idea of a scaled back QOF.

An RCGP spokesperson said: 'The QOF review provides a number of opportunities and we have made it clear that we would like to see a quality improvement component introduced as part of this.'

But they stressed that 'while the college sits on the advisory review group with the GPC, it will be the sole responsibility of the GPC to negotiate the content of the contract'.

The GPC has previously said it wanted QOF to be 'retained but reformed.'

Scottish GPs are no longer participating in QOF, while QOF in Wales has been reduced to disease registers.

Among GPs responsing to a Pulse survey last year, nearly half were hoping to see it abolished.

Readers' comments (25)

  • "Professor Marshall said the new system would be 'a high-trust, profession-led, quality improvement scheme"
    That's what was said about QOF in 2004! Look how it turned out.

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  • QoF should go completely and people should be reminded by media to remember their appointments and health issues and go for their annual checks. No incentives and no penalties for Doctors if patients don't look after themselves - let people take back control and let's not babysit them.
    As far as funding issues are concerned, that is an issue that needs to be addressed - we should not have to rely on QoF as a funding lifeline for Practices.

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  • I wnder how many Practices are paid or not paid for deprivation/distance from surgery etc - it's on the Fringe details on the Exeter Capitation statements. Yesterday there was an article mentioning deprivation payments are being made but st present these are being totally ignored for some Practices in England and they are being paid only as per their weighted list sizes. Institutional racism or we have a class of Windrush GPs created by unscrupulous fanatics in NHSE?

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  • So QOF income scaled back but still have to the same amount of work....then new (more) work just to maintain existing income....absolute genius RCGP!

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  • Nightmare - cqc will insist we will have todo all the work and there will be no payment

    Instead we will have to do more work and it will definitely not be high trust!!

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  • Why is the RCGP pushing this? It’s outside of their remit by a country mile. And... how is the income being replaced?

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  • So it's ok now if I ignore Qrisk, don't bother about statin, don't bother about checking blood pressure while dealing with blood pressure?

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  • Rogue1

    If the money attached to QoF is shrinking by that amount, then so should the work that goes into it. As long as they don't continue to expect us to keep up all the markers, for less than a fifth of the original pay!

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  • Sounds like Prof Marshall is making it up as he goes along. Selecting a couple of topics from a menu? How’s that going to work?
    Is this the same Prof Marshall who was a director of the CQC? Because that bunch are sure to come down heavy on all the topics that a practice ignores.
    My practice relies on QOF for 10% of income,
    Scrap it, fine, but put the money back into global sum and don’t give us any more hairbrained unevidenced schemes. This just sounds like a bigger stick to beat us with

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  • Couldn't agree more Copernicus!

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