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GPs buried under trusts' workload dump

GPC reveals list of 'unworkable' proposed QOF indicators

Exclusive: Nearly a third of the new QOF indicators the Department of Health wants to impose on practices as part of the GP contract deal next year are ‘unworkable’, says the GPC.

The GPC claims the list of seven indicators – seen exclusively by Pulse – either require GPs to refer patients to services that are not widely available, or require a disproportionate amount of work for practices

They include incentives for encouraging hypertensive patients to exercise and drink less, referring patients with diabetes to structured education programmes and heart failure patients to cardiac rehabilitation.

In changes the GPC called ‘unsustainable’ for practices, the Department of Health announced it proposed to accept all the proposed changes to QOF from NICE, meaning 14 new indicators would be introduced to the framework from 2013/14 and a further 14 would be retired.

But Pulse has also learnt the Government also intends to impose a further eight indicators from the NICE menu, which were not put forward for negotiation this year.

This would mean, under the proposed deal from ministers, the introduction of 22 new QOF indicators, changes to four indicators and the retirement of 14 indicators, resulting in the loss of 109 QOF points.

This is in addition to the triple whammy of a hike in upper thresholds, the removal of incentives for the organisational domain and the potential loss of nearly £20,000 in QOF points.

Ministers also proposed retiring all the indicators in the organisational domain except those for the quality and productivity indicators and those for public health, meaning an additional 153 QOF points will be lost.

This would mean practices have to cope with the removal of indicators representing 26% of current points in the QOF. The GPC told Pulse that some of the points will be returned to QOF by introducing new indicators, but overall the size of the framework will shrink by 14% under the DH’s plans.

This represents a loss of £18,659 per year for the average practice using the current £133.76 per point allocation for 2012/13, although whether the amount allocated to each QOF point will rise to take account of this is yet to be confirmed by the DH.

The DH said the plans were designed to ‘focus on better care’ rather than reward practices for administrative tasks. But the GPC said that the move could be dangerous for patients and would introduce QOF indicators that involved referrals to services that were not universally available or would be too work intensive for practices to deliver.

Dr Laurence Buckman told Pulse: ‘They want us to accept all of the NICE proposals for QOF changes. Even the ones that are not safe for patients.

‘It is not sustainable. The time has come for GPs to say that we can’t do any more work. It doesn’t make me less knackered if you pay me more.’

Dr Kathryn Griffith, a GPSI in cardiology in York, said: ‘A lot of NICE indicators tend to be unnecessary because they are more of the tick-box variety. To just ask the question if a hypertension patient takes regular exercise is completely meaningless. It doesn’t add a lot of extra work, but equally will not be meaningful.’

A Department of Health spokesperson said: ‘Improving patient care is our priority - GPs should only get additional funding for the quality of services they offer. It is not true to say the new indicators were not discussed during negotiations or are unworkable. All of them were piloted by NICE for at least six months.’

 

The full list of NICE guidance flagged as ‘unworkable’ by the GPC

Hypertension:

  • The percentage of patients with hypertension aged 16 to 74 years in whom there is an annual assessment of physical activity, using GPPAQ, in the preceding 15 months         
  • The percentage of patients with hypertension aged 16 to 74 years who score ‘less than active’ on GPPAQ  in the preceding 15 months, who also have a record of a brief intervention in the preceding 15 months             
  • The percentage of people diagnosed with hypertension (diagnosed after 1 April 2009) who are given lifestyle advice in the preceding 15 months for: smoking cessation, safe alcohol consumption and healthy diet.

Diabetes:

  • The percentage of patients newly diagnosed with diabetes in the preceding 1 April to 31 March who have a record of being referred to a structured education programme within 9 months of entry on to the diabetes register     
  • The percentage of patients with diabetes who have a record of a dietary review by a suitably competent professional in the preceding 15 months              

Heart failure:

  • The percentage of patients with heart failure diagnosed within the preceding 15 months with a record of an offer of referral for an exercise based rehabilitation programme         

COPD:

  • The percentage of patients with COPD and Medical Research Council (MRC) Dyspnoea Scale ≥3 at any time in the preceding 15 months, with a subsequent record of an offer of referral to a pulmonary rehabilitation programme                       

Readers' comments (18)

  • Vinci Ho

    'You guys are earning too much from QOF . Time to make it impossible for you to acheive . We want the money back . Ha Ha Ha!'

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  • This is just getting stupid now

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  • How about adjusting QOF thresholds to the top Quartile of the achievement in the Palace of Westminster?

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  • If this is pushed through, how much of the CCG Commissioning Budget will have to be allocated to providing the additional services demanded by NICE/TPTB?
    And which existing services will be allowed to be reduced to pay for them?

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  • This is what occurs when those with little practcal experience of healthcare are allowed to "play" at how to make it work. If the current planning by the CON-DEMS continues, this will be no problem because as soon as the multiple U turns have been performed non of the above will happen.
    I liked PG Paige's suggestion, all future trials regarding NHS changes should be trialled within the Palace of Westminster before publication.

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  • Peter Swinyard

    hypertension targets require compliant patients and more nurses. We don't have the former and can't afford the latter (even if you could find them). Diabetes targets assume that there are dieticians etc sitting about with nothing to do. Right. Heart Failure and COPD indicators assume that there are rehabilitation programmes. Oh dear. Impossible? Insulting!

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  • Clinically, I agree with the content of the indicators.

    But economically, I think the government needs to make their mind up - either fund adequately and do all the (clinically) right things or admit they have no money and the country can't afford such intense monitor.

    Either way there is only so much a primary care can absorb! I write this in between patients having not had time for lunch again........

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  • The third indicator on this unworkable list appears to be an easier version of current QOF indicator PP2?

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  • Presumably the issue is around the threshold?

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  • designed to achieve failure?

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