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GPC: QOF opt-out will let patients down

The GPC has warned that a local deal for practices in Somerset to opt out of the QOF completely will worsen patient care and undermine the stability of the national contract.

The deal – finally given the go-ahead by NHS England’s executive this week – leaves GPs in the county ‘doing no more than many other practices in other CCGs are doing in addition to QOF’ said GPC deputy chair Dr Richard Vautrey.

Pulse has learnt the 80% of Somerset practices have so far signed up to the locally agreed enhanced service, which allows them to stop recording the large majority of QOF indicators while maintaining their current level of income from the QOF.

The final draft of the enhanced service specification says that practices will have to ‘work collaboratively to meet the needs of patients’ and ‘improve communication of patient needs through shared records’ in return for maintaining their funding.

It adds: ‘Practices will work with other NHS and social care agencies at a federation level to develop (and implement where practicable) local plans including pilot proposals, to improve integration between general practice and urgent care services.

‘The plan will include improved communication of patient needs through shared records/ use of special notes.’

This will be measured on a quarterly basis, it adds.

It also calls for practices to ‘work with other NHS and Social Care providers to develop (and implement where practicable) plans (at a federation level) to implement the CCG Long Term Conditions Framework’, which includes ‘personalised care planning for patients with long-term conditions’.

Practices will also be required to develop ‘clear plans to work collaboratively to meet the needs of patients’ with other practices.

Finally, it says: ‘GPs will take a discretionary approach to QOF indicators, based on individual discussion with patients about their needs and aspirations.’

Dr Matthew Dolman, chair of Somerset CCG and a GP in North Sedgemoor, said he was confident practices would continue to deliver high-quality care and insisted the work would lead to benefits for patients.

‘We’re confident as a community that quality will be maintained. The future is how do we manage complex comorbidity and the frail elderly in an integrated way with a workforce that is  sustainable. This is only a framework, we acknowledge that, but the exciting thing is people can learn from it and use it to develop primary care elsewhere.’

Dr Dolman acknowledged GPs in other areas may feel Somerset practices were being let off with less work.

He said: ‘Yes, but we got in there first I guess. It’s a pilot, there’s learning to be had – we’re not saying it’s definitive but we can feed that into negotiations for next year. As we know primary care has got to change – the whole system has got to change – so let’s learn together.’

But Dr Richard Vautrey, deputy chair of the GPC, said he was ‘amazed’ NHS England had approved the enhanced service with no clear measures of the alternative work undertaken and said the specifications amounted to no more than work practices elsewhere are doing anyway, on top of QOF.

Dr Vautrey told Pulse: ‘We have grave concerns about this scheme and wonder whether NHS England have actually read the details. It is no more than many other practices in other CCGs are doing in addition to QOF and other core elements of the national contract…It is extremely vague, it’s very loose and it’s amazing NHS England has actually approved this.’

Dr Vautrey said patient care was at risk as a result of the changes. He said: ‘Patients will suffer – that’s undoubtedly the case. We’ve dealt with the bureaucratic and box-ticking aspects of QOF that were really superfluous and the bulk of what’s left is now clinically appropriate – and supports structured management, so whether you’re in Somerset, Surrey or Suffolk you are going to get the same level of care.’

‘Now NHS England can’t guarantee that and yet they’re supposedly a national body commissioning a service right across the country and I think they are letting patients down.’

NHS England said the plans had been scrutinised ‘rigorously’. A spokesperson said: ‘As you would expect the process and plans have been rigorously scrutinised and evaluated. This is to make sure they are of the highest standard, will deliver on every level including clinical quality as well as wider health outcomes and the organisational development of primary care in Somerset.’

Readers' comments (7)

  • Well done for negotiating a good deal - important to ensure we keep the work load to a managable level and discard clinically less important tick boxes.

    However if I was a patient with chronic disease, would I be happy knowing I will no longer be monitored routinely? Probably not.......

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  • There is no evidence this deal is patient-centred at all, it is just a handout to the practices, brokered by the CCG who of course, come from the practices, and so gain financially from the deal. You have to hand it to them for sheer chutzpah!

    Who thinks this is a good idea? Other of course, than the ones getting the handout. When CCGs co-comission primary care, we'll see a lot more of this.

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  • unfortunate but going to become increasingly common. The grassroots including the LMCs have lost faith in the ability of the GPC to negotiate a reasonable national contract and so local negotiations will be increasingly common. Strange one and ironic that even though there is mpig withdrawl and PMS funding reviews coming up, there will be funding variability nationwide for practices dependant on local contracts in the future . A pointless recycling exercise in my opinion when PMS allows local contracting arrangements. All doh policies seem to be change for change sake with no coherent long term vision or planning or is there a vision we are not aware of? . I'm not sure whether NHS England is stupidly oblivious or extremely clever because the current route the are going down is only going to lead to the destruction of the NHS. And the gpc are complicit in this with their inaction.

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  • Sounds like a gpc freak out! How is this not good for patient? Bad for the gpc and the national contract. But clever NHS England know this and are laughing! Divide and rule!

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  • Vinci Ho

    I can understand the arguments from both sides but should we have more details and facts about this deal, editor, before all kinds of judgement are made .
    Will be interested to have actual comments of colleagues involved in this deal. After all , it is about our patients. QOF is never biblical but it is important that patients are still properly looked after.
    I do not believe in free lunch anyway.....

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  • GPC, quite honestly why should we care? You have let us down. The govt has let us down. The right wing elements of the press constantly attack us formbeing greedy and lazy - because of QOF.

    I think this is a hugely positive step for GPs and their families.

    Time to rescue the profession for itself and make it tolerable and rewarding once more

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  • desperate times need desperate measures

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