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Gold, incentives and meh

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)

  • Barmy, so we will end up doing the same amount of work, but earn less. Oh but we can maintain our income by doing even more work with dwindling resources. What planet are these idiots on, and how can they have any claim to represent the front line of primary care. Disaster

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  • Sounds like extra work for same money to me. Not been in the game many years but already seeing through this lazy tactic. Hopefully the time has come for GPs to call an end to this stealth workload dump.

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  • David Banner

    Anyone who thought that QOF money would simply be added to the Global Sum is extremely naive. At least QOF is the devil we know, and most of us have it sussed, but in keeping some indicators (probably the hardest to achieve) then throwing in new Enhanced Services (Lord knows how much work they will involve.......lots, probably) just to maintain income is the worst possible outcome.
    Yet another massive own goal from people who don’t seem to realise that General Practice is on its knees.

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  • Healthy Cynic

    Anyone who states that QOF has 'had it's day' should question critically whether the original QOF indicators were truly valid. Are we happy to continue this cycle in medicine where everything that is vital today can be worthless tomorrow? For instance, the provision of obesity and smoking services as public health measures?

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  • Just Your Average Joe

    QOF may be annoying - but the targets and reminders lead to better patient care, and bring income to practices. Most practices get close to full QOF points.

    The DOH want with the help of certain Ivory Tower GPs to scrap it - as they feel it is embedded into GP care now, and will expect all the work to continue now for free - when there was originally money to transfer this work out of hospitals into Primary care.

    We have hired staff inc admin/nurses to ensure it is done, but when expected to continue for reduced money/free - we still have those costs, and GP time used to do this.

    If scrapped I expect to be able to refer all COPD, asthma and diabetic etc patients back to hospitals to let them do the work again - Nope that will not be allowed.

    Big brother CQC/CCG/NHS England etc looking at referral patterns/rates and monitor those who stray from previous historical reductions.

    This work however you frame it will become another financial tax/noose around struggling practices, and the 'New menu' to replace it is more work, now taken from Public Health who are failing to deliver it in their budget, to be done by Gps at again a fraction of what Public health are given to do it.

    BMA - stand up for GPs - All QOF money straight into global sum, new money for the new menu - or resign from representing us.

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  • Please, just stop. Most of us now have systems in place to achieve QOF payment and while tedious at times, it does at least aim for quality.. Scrubbing it and replacing it with different schemes to implement (and public health ones at that if the examples given are typical) in order to receive the same payment is not an acceptable option. Are these people unaware of the crisis in general practice and how little it will take for some of us to walk away? Why should GPs have to keep proving our worth depending on the bright ideas of whoever is in charge? Does any other group’s contract change so dramatically so frequently? If the alternative is worse, a period of stability iwould be welcome.

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  • Really unhelpful if you are still expected to do the work and the money is being taken away.

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  • QOF may be past is sell by date. It's not as if it has made a difference to patient outcomes, despite the alleged evidence base of the QOF ideas (such as in diabetes) which makes you wonder about the evidence base of all we have been told to do.

    I am not sure that the NHS should abandon Fee for Service, indeed it should develop some more. There are merits to parts of the Australian system which could be used here. You could pay one fee for a telephone consult, another for a Babylon/telemedicine and proper one for a face to face. Fees arranged to discourage patient churn, such as aa much higher fee for seeing a patient you have not seen for a year and lower fee if seen last week.

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  • GP needs stabilising. Get the basic service right before more new things. All focus needs to be on that. Get rid of QOF and replace with a few locality agreed targets as and when basic service can stand it.

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  • Commissioners even have a name for this "you do it often enough so you should do it for free". It's called "business as usual" and it seems once they decide the activity is in catagory, they don't have to pay for it.

    As already mentioned, CQC will not be giving up the idea. So welcome to doing more work for less.

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