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Local area teams block QOF suspension bids as CCGs queue up to copy Somerset model

Exclusive CCGs across the country who have asked to follow the lead of GPs in the South West and opt out of QOF reporting for the rest of the financial year are seeing their requests turned down by NHS England, Pulse can reveal.

GP commissioners in at least four areas have asked local area teams to relax practices’ QOF reporting requirements, after Pulse revealed that GPs in the South West had struck a deal to ditch QOF work between now and April.

CCGs, LMCs and the local area team in Devon and Cornwall have agreed that GPs can stop work on the QOF indicators that will be removed in April – worth a total of 341 points – in return for starting work early on the new unplanned admissions DES. In Somerset, GPs have been told they can stop all QOF work between now and April, and that the time saved should be used as ‘thinking space’ to ‘redesign’ the QOF from April.

NHS England has backed the move in the South West, saying that it is an example of an ‘innovative solution to commissioning primary care’ – but area teams around the country have rejected bids from GPs looking to follow suit.

Pulse has learned that CCGs in Birmingham, Cumbria, Kent and North Yorkshire have all requested a similar suspension of the QOF, but so far none has been able to reach an agreement.

Dr Jonathan Wells, chair of Redditch and Bromsgrove CCG, said he immediately approached his local area team – Arden, Herefordshire and Worcestershire – and Birmingham LMC about the ‘very sensible’ arrangement in Somerset, but was told a similar deal would not be agreed locally.

Dr Wells said on Twitter: ‘Area team say no way and express surprise at Somerset decision – point to single operating model.’

Cumbria CCG also initiated informal discussions last week to try to cease work on QOF indicators due to be retired in April, but CCG chair Dr Hugh Reeve told Pulse a deal was looking unlikely.

‘We have entered into discussion with the area team about implementing the early retirement of QOF indicators as they have done in Devon and Cornwall, in exchange for starting work early on the frail older people DES,’ said Dr Reeve, a GP in Grange-over-Sands.

‘We have had email discussion over the past week. [The] only way to implement it would be to take the Devon and Cornwall approach and implement it without change.’

Asked if the agreement looked likely, Dr Reeve said he was ‘not that hopeful at [the] moment’.

Lancashire and Cumbria LMC chief executive Peter Higgins said the LMC would support the move if the CCG could pull off the deal.

Mr Higgins told Pulse: ‘As an LMC, we’d say anything to reduce unnecessary burden on GPs at this stage would be welcome, provided it didn’t leave the GPs vulnerable.

‘There has been some concern at a national level that we don’t want regional QOF – and I would agree with that. We do need to hold the line. But particularly with indicators that are going to be retired next year anyway there is some sense [in it] and we would be happy to explore the possibilities.’

However, a similar request from GPs in North Yorkshire has been turned down because the request came ‘too late’. And according to NHS England, northern local area teams have no plans to negotiate anything - apparently ruling out a deal in Cumbria as well.

A spokesperson for NHS England North West and Yorkshire and Humber regions said: ‘There are no agreements in place currently in any of these areas [and] no plans in place [to] make agreements in each area.’

In Kent, Thanet CCG is also hoping to institute Somerset’s model. But while the CCG described its local area team as having been ‘supportive so far’, the area team denied that any discussions had even taken place.

Dr Tony Martin, chair of Thanet CCG, said: ‘We are looking at how we can accelerate community based care as an alternative to hospitalisation. We have an ongoing project to redesign our district nursing teams to be health and social care support units, both looking to invest hospital disinvestment and the better care fund.’

‘The increase in GP workload will of course need supporting… For the rest of this year the option of having a Somerset type agreement is certainly something we will be asking our members to consider and [we] have had outline discussions with the area team. We would of course need members’ agreement and to work with the LMC.’

Dr Martin added: ‘At the moment we are planning to March end and the area team are supportive as far as we have discussed.’ 

However, a spokesperson for NHS England London and South denied any negotiations were underway.

The spokesperson said: ‘The Kent and Medway Area Team are currently not planning or discussing the new scheme. The scheme has interested people but no discussion or planning is taking place.’

Dr Nigel Watson, chair of the GPC’s commissioning subcommittee and chief executive of Wessex LMCs, said many LMCs would have liked to initiate discussions on stopping work on QOF works which will be retired anyway. But he also warned that a wider redesign of the QOF after April, as is planned in Somerset, could undermine the national GP contract.

He said: ‘Bringing in QOF changes early seems like an eminently sensible idea – but I think it’s probably too late for other areas [to do this], by the time we’ve got agreement with the CCGs and the area teams. It would have been helpful if that had been available to all of us early on.

‘I’m slightly more confused by what Somerset are trying to do – which seems to be breaking away from the national contract. QOF is a significant part of GP income. The work done nationally to come to agreement on QOF cannot be replicated locally and moving potentially to CCGs deciding what goes in QOF is hugely dangerous. I’m not sure the LMCs have the capability or capacity to negotiate QOF on an annual basis.’

Dr Watson added: ‘I have to say I’m quite surprised at this with the “single operating” framework, controlled by NHS England headquarters – we were told area teams were very much part of a single organisation for England. This seems to be driving a coach and horses through it.’

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Readers' comments (3)

  • norfolk have joined the rush
    it appears the LAT have no system to handle the QOF data so this is more of a get out of jail card for NHS england and I expect will become national.

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  • Phil Yates

    It's clear that QOF is a blunt instrument (e.g. tight HbA1c targets are correct for 30 year olds, but are probably damaging in 80 year olds) and needs amending / reducing but regulation of primary care is not going to go away.
    What is needed, and what Somerset Local Area Team is trying to do, is give some space for GPs to think much more laterally about what structurally is needed to support primary care for a broader future role.
    So unless other areas are prepared to think about this its probably unlikely their LATs will just 'let them off' QOF.

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  • it is not about thinking laterally they just cant process the qof

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