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GPPAQ could face the axe as GPs lobby for its removal from QOF

Exclusive GP leaders are lobbying for the GPPAQ questionnaire and hypertension targets to be removed from the QOF next year, as NHS England seeks opinions on how to reduce the size of the framework.

GP organisations including the Family Doctor Association and the NAPC said they have been asked by NHS England to come up with ideas for which areas of QOF should be cut next year, and have suggested overly stringent diabetes and hypertension targets and the GPPAQ indicators should be removed from the framework.

The move has been welcomed by the GPC, who said any ideas on reducing bureaucracy for GPs would be welcome.

As previously revealed by Pulse, NHS England has a long-term strategy to shrink the QOF to reduce ‘tick-boxing’ targets GPs are tied to and free up resources for other incentive schemes.

Dr Peter Swinyard, chair of the Family Doctor Association, said he had advised NHS England to get rid of ‘bonkers’ QOF targets around physical activity next year.

He said: ‘I know that the Government wants to simplify QOF for the next financial year - which I think most of us would welcome in one way or another. They are still talking to various representative groups trying to find out what is actually good in it and what they don’t want to lose, and what in it is just for tick-box gains.’

He added: ‘The physical activity questionnaire is just plain bonkers. As a GP for 30 years I can tell an athlete from a couch potato. There are various things that we have in QOF which are just tick-boxing. I think what we need to avoid is the excessive detail.’

Dr Charles Alessi, chair of the NAPC, who has also been consulted by NHS England, said he was ‘encouraged’ bosses were thinking about how to reform QOF.

He said: ‘We have argued for a long time that we need to move to more population health metrics rather than individual health metrics. We are putting pressure on everyone we can, including NHS England, but not only NHS England, to look at new contractual forms which may deliver better population health.’

NHS England said that while it is not formally consulting GP organisations on the matter, its long-term strategy to link performance indicators more closely to NICE guidance means this will feature as part of all negotiations.

A spokesperson said: ‘We are talking to clinical domain leads just as part of our usual process of looking at the indicators like we do every year. But we have the long-term aims of linking performance indicators more directly to NICE indicators right across the whole health service so obviously whenever we are discussing performance indicators those sort of issues will be part of negotiations.’

An NHS Employers spokesperson said: ‘We will be discussing QOF as we always do as part of the negotiations on the GMS contract between NHS Employers on behalf of NHS England and the GPC. Neither party comments on the progress of these negotiations whilst they are ongoing.’

GPC chair Dr Chaand Nagpaul welcomed the move: ‘Certainly if NHS England is interested in reducing bureaucracy then there are elements of the QOF that really need to be revisited and certain indicators should be removed in our view.

‘We don’t have a policy for which elements should be removed but we have always been unhappy with the GPPAQ questionnaire and said having such stringent blood pressure thresholds in England is illogical and may result in overtreatment.

‘So we think the elements of QOF that are not evidence based and are forcing GPs to chase targets should be removed. We would like that money to be released and put into core GP funding. We haven’t started negotiations, but certainly if NHS Employers are willing to look at this then that is good.’

Readers' comments (6)

  • meanwhile we over treat and ask meaningless questions.

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  • The problem with QOF is that it has been designed by academics who know little of real life General Practice and usually work in leafy, affluent areas shielded from tough, rough and really hard patients. I want these GPs to be tested out in the harshest practices so they can "learn" about the sharp end. Throw away those tweed jackets and bow ties and learn how to talk to the patients in the language they understand.

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  • hmm, a cunning ploy... make the qof targets ridiculous, get lots of complaints, remove them with GP approval and with that, also remove the funding.

    ergo, yet another salary cut.

    or .... reinvest the money into making us take back OOH!

    = all GPs leave the country

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  • @ anonymous 9.46am.
    Perfect analysis and conclusion.

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  • Can't we recognise that it is continuous change and tinkering that causes a lot of work/angst. At the moment I don't give a monkey what's in or out of QoF, if we could just leave it to run for a few years then we'd be able to see what works and what doesn't properly. We would then be in a good place to lobby changes that are effective for our patients.
    Change fatigue.

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  • HOORAY. What about ckd? See last week's BMJ. Or depression? Or ED? OR FRACTURE RISK?

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