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GPs 'not ready to give up QOF' in contract overhaul

Exclusive QOF is likely to remain in the new Welsh GMS contract in some form, the BMA's GP Committee has said.

Speaking at a conference on the future of primary care, GPC Wales negotiator Dr Peter Horvath-Howard said there were no plans to abolish QOF at the moment but they would be looking to ‘minimise’ the framework and move more of the funding into the global sum.

It was revealed in May that the Welsh Government and GPC were starting negotiations that will see an overhaul of the GMS contract with the future of QOF a key issue on the table.

It comes as the Welsh Government temporarily suspended QOF earlier this year to relieve pressures on GPs, and agreement was reached for 2017/18 that some points would be ‘inactive’ and not related to payment.

But speaking with Pulse, Dr Horvath-Howard said: ‘I think there is a feeling we are not ready [to get rid of QOF] at the moment.

‘There is a reluctance on the basis of you have to be wary of what would come instead.’

But he added that they have had a ‘clear message’ from GPs that they want to reduce QOF.

‘The GPC Wales position at the moment is we are likely to retain an element of QOF and see how things go.

‘We have to consider there is a stability issue as well. In a way it is an acceptance that the profession is in trouble and we have to put some things on hold.’

Discussions on overhauling the GMS contract have just begun.

A stability agreement was reached for 2017/18 with a 2.7% uplift and new enhanced services for care homes, diabetes and warfarin management.

The GPC has said their focus for this year is on workload, workforce and resources.

Last man standing liabilities, indemnity, making greater use of pharmacists and other health professionals and improving cluster working will also be addressed as part of contract negotiations.

In her LMCs Conference speech in May, GPC Wales chair Dr Charlotte Jones said they would be delighted to see the commitment to resources seen in England and Scotland.

For this year's Welsh GP contract, 40 points linked with depression COPD, heart failure, blood pressure, and cardiovascular disease were removed and transferred to the cluster network domain.

In guidance to GPs, the GPC said it reflected their ‘intention to reduce unnecessary bureaucracy and place greater reliance on cluster based peer review of clinical indicators deemed to be embedded in clinical practice domain’.

Is QOF coming or going?

In England, GP leaders were instructed by the LMCs Conference to negotiate to retain the QOF, marking a U-turn from the GPC's previous policy.

The BMA's Urgent Prescription for General Practice, published last year, called for the end of the QOF while returning all related investment into core GMS/PMS funding.

But at the LMCs Conference in May, LMC delegates voted in favour of a motion that said ‘disinvestment from QOF is no longer desirable’ and called for the GPC to agree a revised framework with indicators that are ‘evidence based’ and ‘clinically relevant’.

Earlier the same month, Pulse had revealed that GP leaders have met with NHS clinical chiefs to discuss altering QOF diabetes indicators next year, casting doubt on whether the QOF actually would be abolished in next year’s GP contract.

However, this all comes after NHS England chief executive Simon Stevens has said that the QOF has reached the 'end of its useful life', while the 2017/18 GP contract announcement included a stipulation that a working group would be set up 'to discuss the future of the QOF' after 2018.

 

Readers' comments (8)

  • Cobblers

    Remove QOF. Put all payments into a so called 'Global sum" which would overall be the same for each practice on a weighted per capita basis. (Deprivation might be an added payment)

    Agree what they would get for that money.

    No added bits and pieces. KISS.

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  • No Practice in England is paid Deprivation or Rurality payments - This is according to an email from the Chief Finance Officer of NHSE in Kent. It is based, we are told, on an assertion from NHS Digitial; who have failed for months to confirm this in writing.
    So if you are talking of payment for Deprivation as an add on - sorry it's not happening - if you wondered what its all about - Welcome to 'Grey' Kent and the maze of NHSE and NHS Digital which is so shady that it reeks of corruption.

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  • LMCs and BMA officials are not interested in liquidation of QoF because there are vested interests. There is a serious lack of transparency which is very convenient to our cardigans sitting in these organisations.
    If QoF is liquidated, it would bring in a bit of pairty in payments to Practice across the board. And that can't be right, can it? The 'Establishment' would choke over this mishap!

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  • Who, honestly, would trust NHS England to re-invest the QOF money in our baselines?
    Worse, they might give the money to our CCGs and then we'd NEVER see it!
    Let's keep QOF. We've all got our systems in place to achieve a high percentage of the available points. We can't afford any further financial hits.

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  • Do not give up QOF without a fight.

    Please look at NHS Rightcare, this comparative method is what NHSE want to use to drive down cost on the basis of differences in clinical practice.

    It is being used as a way of looking at economics outside of clinical outcomes as much of the data is so open to interpretation it is meaningless.

    This Pharma will take a hit as it will act against new drugs being used (so thats my bias!).

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  • Cobblers

    People stop.

    Who gives a shit if QOF goes?

    As long as the payment per patient is sufficient. You can debate that amount until the cows come home.

    No complexity. Agree what you will do in the contract and Foxtrot Oscar to the rest.

    BUT Keep It Simple.

    NHSE loves complexity and smoke and mirrors. It thrives on it getting one over on GPs.

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  • 9:28; There is no transparency in the system and I quite agree who gives a damn if QoF goes.
    We've been moaning about wasted time chasing patients as if they were mentally impaired and unable to take responsibility for their own health and lives. We write letters to thousands of patients beseeching them almost to come in so we can get our money( isn't that what it comes down to at the end of the day?).
    Now when there is talk about liquidating QoF, we have protests - Ooops we'll lose money. No, some will lose money, but most will gain peace of mind and some patients will finally need to grow up instead of getting pampered like spoilt children. We are able to check our MH patients without QoF, so what's the worry.
    The only certain payment in the system is the minimum global sum which is something that would be uplifted for all Practices if QoF went. Thank Goodness for that. Although, malicious NHSE can still put you down if you don't 'behave' by reducing your list size by a 100 patients every time there is an uplift because you've stepped out of line. They can blame it on the Formula which none the country can question - there is no Institution which can challenge this - total anarchy.
    Let's get rid of QoF and have no doubts about it. The ordinary GP has no pecuniary benefit in keeping this headache.
    The time and money invested and the stress of attaining targets and then having to look at your surprisingly reduced prevalence that nullifies all the damned work undertaken, will only hasten your descent to your grave.

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  • Unscepted | GP Partner/Principal13 Jul 2017 9:40am

    What you said unfortunately will fail as the data sets required for Rightcare will mean you will need to collect virtually all the QOF data anyway and the stick will be CQC or financial penalties. All this without QOF monies in the global sum - as it will be diverted to CCGs for ACO project funding.

    So it will be a lose lose - tread carefully.

    I see nothing positive in losing QOF for practicing GPs.

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