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GPs told to continue working on retired QOF indicators to 'demonstrate good patient care'

Exclusive GPs have been told by NHS managers that they are ‘required to’ continue providing services that were dropped from QOF as part of this year’s contract negotiations to demonstrate ‘ongoing delivery of good patient care’, a claim that has been rubbished by the GPC.

An email from the Health and Social Care Information Centre (HSCIC), distributed via NHS England local area teams to practices, said that practices had to agree to data relating to 24 retired indicators being extracted by 23 January to prove that they ‘continue to provide the services linked to these indicators’.

The indicators, which were scrapped for the 2014/15 GP contract, include a direction to use the criticised GPPAQ questionnaire to ascertain exercise levels in patients with hypertension, as well hypertension blood pressure targets that had been criticised for risking overtreatment of patients.

As part of the contract, NHS England said it would ‘continue to collect and publish data, as far as possible, on the relevant interventions and outcomes in order to support practices in promoting ongoing quality improvement’.

However, the GPC has strongly disputed that this would involve continuing to provide these services to the same extent, and has issued a warning note to all practices informing them that the email from HSCIS and and local area teams is inaccurate.

There is no indication about how NHS England will enforce this, but the GPC said there was an ‘anxiety’ that the data would be used to measure practice performance similar to the CQC’s ‘intelligent monitoring’ data and that it could be used by CCGs looking to implement their own local versions of QOF.

The note from HSCIC, sent to all GPs, said that the funding had been removed from QOF and put into the global sum, but the services still needed to be provided.

The document said: ‘The indicators included in this customer requirement were previously included and funded through QOF 2013/14. These indicators have been retired from QOF and payment has transferred to the core GMS contract for payment through the global sum.

‘It is a requirement for general practices to ensure they continue to provide the services linked to these indicators. This data extraction will help inform commissioners that general practices are continuing to do this, demonstrate their ongoing delivery of good patient care, and provide statistical information.’

However the GPC said that they had only agreed for the continued extraction of the data linked to the indicators, not for the practices to do the work.

In a warning note to practices, the GPC wrote: ‘GPC has heard a number of understandable concerns regarding recent communications from [HSCIC] about retired QOF indicators for 2014/15… HSCIC suggests that “it is a requirement for general practices to ensure they continue to provide the services linked to these indicators”. This statement is incorrect and is not what was agreed by GPC, NHS Employers and NHS England in the 2014/15 contract negotiations.’

It added that the GPC ‘anticipates a large fall in the recording of many of the retired codes’ as practices ‘now work more appropriately’.

GPC said it was especially concerned about the wording of the document in light of the CQC’s recent use of QOF performance and patient survey results to publicly band GP practices into ‘risk rating’ categories.

It wrote: ‘Following the wholly inappropriate and flawed use of coded data by the CQC as part of its “intelligent monitoring” risk assessment, practices are understandably anxious about how data that is extracted will be used.’

Dr Robert Morley, head of the GPC’s contracts and regulations subcommittee, said: ‘The document is from HSCIC and GPES but forwarded via area teams by NHS England. It directly contradicts the contract changes agreement and GPC is taking the matter up urgently with NHS England.

‘My hunch is that this probably represents cock-up rather than conspiracy but nevertheless suggests a deeply worrying lack if understanding by those who should know better of GP contractual obligations, clinical autonomy, the difference between essential services and QOF and the nature of the agreement that was reached.’

He added that there were implications around ‘how practice performance might be judged in future, for example by CQC. and the ‘increasing likelihood of local deals replacing QOF’.

He added: ‘We’ve already seen one disastrous example of this, of course, with the CQC “intelligent” monitoring debacle for those practices that had opted into a local QOF all being given a “high risk” ranking.’

HSCIC was approached for an explanation but said this was a matter for NHS England.

Pulse is still waiting for a clarification from NHS England.

The GPC negotiated wide-ranging changes to the QOF ahead of the 2014/15 contract, including the retirement of 24 indicators worth a total of 185 points from the clinical domain and 14 indicators worth 33 points from the public health domain.

 

Readers' comments (28)

  • Took Early Retirement

    Err....it's rubbish. Someone needs a kicking. Funny how we NEVER find out who is responsible?

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  • Took Early Retirement

    Sorry- meant to also say

    How can you now be told that you HAVE to do something that was voluntary from the start!

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  • I agree with John, voluntary so should not be measured.

    Whereas it might be argued that giving advice and using certain measurements is good care (clearly not always true for QOF), it is certainly cannot be argued that coding it in a specific way in the notes is good care.

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  • I despair- why do we have to put up with nonsense. We should regain our self-respect as a profession and as a profession be responsible for clinical priorities. If we are going to be treated as (and believe ourselves to be) employees then sweep away all this GMC nonsense about professional responsibility and let us be solely subject to normal employee disciplinary procedures.

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  • Someone tell Farage about this he is the only politician who wants to cut the admin and let get back to doing what we do best

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  • absolute trash
    just because something is tick boxed on the pathetic ludicrous qof does not mean real care has occurred..it certainly means time has been wasted on real patient care by these ludicrous robotic data inputs....often incomprehensible and nonsenical..how many billions of desperately needed consulting hours wasted on this idiotic unprofessional nonsense that no other country does for good reason..qof is a lunatic bureaucratic micromanaging abortion that needs to be killed off summarily to free time for genuine patient care..and also to increase gp morale by not any more being treated like children by this idiotic failure designed by a bizarre dictatorial bureaucracy.

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  • Would not surprise me if the woolly GPC actually did agree to this happening during the negoatiations and has once again sold GPS down the river, but in their typical naivety didn't think through the implications of the ambiguous wording they agreed to. Remember the GPC telling us the clause in the GMS contract that says the govt can change the contract at will, would only be in national emergencies? Remember the GPC telling us that the 2004 contract meant no new work without the funding for it? Remember the GPC telling us that it is a "high trust, low bureaucracy" contract? The naive fairies at the GPC come out of meetings believing any old fantasy they hope for.

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  • Don't get the best bacon by continuously weighing the pig.
    Is anyone that suprised? Everyone sits in their silos thinkin ghow they can acheive their targets and look good to their senior managment by buffing up the figures or showing improvement. The logical end point is failure to improve when every ounce has been squeezed. Then they move on to audit or measure something else. Circle have realised they cannot cope with CQC, micromanagment and no funds; perhaps we need to start pulling our contracts too and leave the NHS

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  • Same goes with C&B and a load of other services piled on with initial payments during the past 10 years. Now these arrogant NHS buffoons (so called Managers) tickle your conscience arguing ;'it is essential for patient care'.
    Wonder how many of them would reduce their salaries by a pound to help keep this 'good patient care afloat'. The pity is that RCGP and GPC don't lag behind seconding them which is a harsh betrayal of GP Trust.

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  • P*** off...........

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  • I hope they are told to go forth and multiply off. time for a back bone from our GPC, the draw a line under this once and for all.

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  • No backbone there! They make a noise about it now and then in a few months time they'll suggest "well you may as well do it!" and then CQc will use the fact yoiu have not sent any data as evidence you do not provide patient services! You can see what is coming next in the language they are using now!

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  • is there anything stopping us from moving back to paper records?

    perhaps we keep the electronic record for major diagnoses, current medications and allergies?

    - anonymous salaried!

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  • I would urge colleague to enlist the support of their LMC if there are any concerns with this and NOT submit data

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  • already given up hope NI GP

    QOF was always a voluntary service.Practices chose to collect Data on certain Disease registers and were then paid acording to which targets they reached.Checks could then be made according to the grade of evidence required.Once moved into Global Sum Equivalent ALL reporting requirements were removed.Practices would continue to provide good clinical care and clinical governance assurrance as to their efforts to continue to do so.THERE ARE NO REPORTING REQUIREMENTS FOR RETIRED INDICATORS.As a side issue how could practices persue these indicators without appropriate search engines anyway?

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  • I know that the BMA have often spouted that GP morale has been low ever since I was a trainee 30 yrs ago. However, the recent vitiation of general practice in the past 6 yrs or so is something on a completely different scale. The new contract in 1990 forced GPs over 70 to retire because they were thought to be a liability. Now the NHS is struggling to retain the > 50 yr old GPs. It beggars belief. I have no doubt in my mind that if GPs were allowed to get on with the work that they wanted to do, then much of the low morale would lift

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  • not sure I can summon the energy to write B****cks - oh yes I can...

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  • Una Coales. Retired NHS GP.

    'I freed a thousand slaves I could have freed a thousand more if only they knew they were slaves.'

    Harriet Tubman

    As someone who grew up watching my mother suffer from domestic violence, I am trained to recognise the signs of chronic abuse. NHS state GPs are being abused! Wake up! You are in a catch 22. You cannot take the government to employment tribunal because you are 'independent contractors', yet you are not independent as the government keeps changing the terms and conditions of your contract and making it more and more exploitative. Even your pension is not untouchable and the terms can be changed as this is exempt from contractual law! Your chronic stress is because working terms are being changed willy nilly and you cannot work any harder and keep sane. And when you recognise you have no breaks for food, the loo, etc., you still live in denial that even your basic human rights are being denied. I don't want you to end in a coffin well before your appointed time!

    I had a Chinese friend at Hopkins who chose IT instead of medicine. She is now wed to a lawyer in SF and they bought a $2.35 million architectual wonderpiece 4BR house last year. No worried about QOF, GMC, CQC, NHSE, CCGs, etc. Once upon a time, doctors and surgeons were the ones who lived in grand houses, but only here in the UK have I seen a doctor live in a ground floor council flat, she bought with her hard earned NHS money. It beggars belief.

    You can still love medicine and care about people, but you have to love and respect yourself first. Please recognise the signs of slavery. The government enticed private GPs away to join the NHS in 1948 by paving the mouths of private doctors with gold, more gold than they could earn in the private sector. Then they piled on the work and kept piling on the work, until an entire generation forgot how to be independent private GPs and earn their own living. Now you live in fear of not knowing how to charge clients if you go private, so you stay put and suffer. Fear of financial poverty is for domestic violence wives who do not have a college education, you have more than that, you have MRCGP, an internationally recognised medical diploma.

    And when they say, but won't you get bored if you retire early? I have never met a bored retired GP. For me, I spend my time renovating my home and browsing the houzz interior design app. Love it. Believe me, wives who do not have to work, do yourself a favour and quit so you can be a good wife and mother if this job is killing you.

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  • Una Coales. Retired NHS GP.

    Sorry that's no worries about QOF, GMC, etc...

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  • Does anyone have any evidence that we are being paid in the global sum for the retired QOF points, for either GMS or PMS contract holders?
    It has proved impossible so far to get a yearly summary for what we should have been paid for our PMS contract in Hampshire for the 2013-14 year, and no budget forecast for the 2014-15 year has been forthcoming either.

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  • It is time for us GPs to behave like true Independent Contractors. We do not have to stay in the NHS at any cost. There are a number of other systems.
    It is time for us, through the GPC, to say exactly what we will do and at what price.
    You know what if that does not suit the DOH, we should just tell them to get lost.
    After all, if you analyse this properly, we will always make a reasonable living seeing 35+ patients a day, as long as we are prepared to charge whoever pays, a proper costing.
    I cannot understand why we GPs are so slavish in a system that is so under doctored.

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  • It has to be the fault of the GPC, who would rather see their profession decimated than make a stand on proper remuneration.
    GPC, do you not think we can survive outside the NHS? Of course we can and handsomely. All we have to do is charge a reasonable fee for everything. Please, please GPC ballot for mass resignation. Or would you rather watch as it disintegrates piece meal, with all who can, leaving and hardly anyone joining?

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  • It appears the GPC, BMA, RCGP ARE the DoH.

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  • We should stand up for ourselves and refuse to tolerate the way we are treated.
    My son's friend ( a teacher) was in a meeting in which the colour pen he used for marking was being criticised by a woman whose class did less well than his.
    He stood up, threw his hands in the air and said " I think I have just resigned"
    He walked out and threw his security tag over his head as he left.
    A letter posted to him was unopened and sent back marked " return to sender"
    He has had no further contact with the school.

    I admire him and am sure he will have a happier life.

    We are wimps..

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  • High time for GPs to unite and take an united action against all this rubbish, BMA must take there lead

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  • Una Coates: Any ideas on commencing private practice and assistance or examples available. Have great premises with parking but don't want to my grave before my time,,,so any thoughts, please share.
    sanjeev@wp.pl

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  • Peter Swinyard

    I find the criticisms of the GPC a little unfair (no, I am not a current member of the GPC although I am on LMC). Our leaders are negotiating with the government with a hand tied behind their backs - as doctors will not, for perfectly good reasons, take industrial action. Look at the pensions debacle - this gave succour to the government that they could trample over us as they will.
    Now age 59, I have just downloaded form AW8 from the NHSPA site - google it! - and am reducing commitment to practice asap.
    My worry is - who will look after me as I get older and more frail?

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  • Definition of 'retired' - no longer working.

    Wish I was!

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