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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'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 certainly means time has been wasted on real patient care by these ludicrous robotic data inputs....often incomprehensible and 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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