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NHS England backs QOF suspension as an 'innovative' way of commissioning GPs

Exclusive NHS England has backed its local area teams in allowing some GP practices to ditch the QOF for the rest of this financial year, saying that it was an example of an ‘innovative solution to commissioning primary care’.

The body said it supported a radical agreement between NHS Somerset CCG and the local area team to ‘switch off’ QOF reporting and pay practices for their estimated achievement for the rest of the financial year.

NHS England said that it was important to encourage local collaboration to ‘deliver high quality services’ and it supported moves to ask GPs to provide new services and making a ‘payment to compensate for loss of QOF income’ as a result.

It also backed a move by area team officials in Devon and Cornwall to suspend work on QOF work that would be removed from the framework in April to focus on other priorities, although it said that it was not a ‘blueprint’ that it was recommending other local area teams to follow and that it would not be suspending the QOF nationally.

The plans to suspend QOF reporting in Somerset from January, and still pay practices what they would have earned under the framework, is designed to encourage practices to participate in a CCG-wide project to ‘redesign GP services’ before April 2014.

But it has caused consternation at the GPC, with deputy chair Dr Richard Vautrey saying that breaking away from the national contract in this way could leave practices adrift if they come against problems.

A spokesperson said: ‘NHS England is committed to working collaboratively with CCGs to support general practice deliver high quality services aligned to the local priorities.

‘As the contract holder for primary care, it remains our position that NHS England should not simply “suspend” on a national basis the QOF indicators that are scheduled to be retired ahead of April 2014. That would require changes to secondary legislation which could not be introduced before the end of the financial year.

‘[But] an area team could, however, reach agreement with its practices that, in recognition of some other services that they have agreed to provide, the area team will make a payment to compensate for loss of QOF income that may have arisen from providing that other service, but this is different from suspending QOF requirements altogether.’

But Dr Beth McCarron Nash, GPC negotiator and a GP in Cornwall, who was part of Cornwall LMC’s negotiations to bring forward QOF changes in that area, said the changes in Somerset were ‘concerning’.

Dr McCarron-Nash told Pulse: ‘Area teams do not have any mandate to negotiate local contracts – they are outposts of NHS England and in legislation they have no jurisdiction.

‘They can – with agreement of NHS England – look at local arrangements, but in terms of deviating from a national agreement they do not have any mandate to do that.’

Dr McCarron-Nash added: ‘I think practices need to be very careful that they don’t end up being offered very stringent [key performance indicators] that actually make them end up with a worse deal.

‘We haven’t seen the detail yet – but certainly I have expressed concerns about practices who whole-scale give up the QOF. Although we’re fed up with the box-ticking, and the monster the QOF had become, what we don’t want is end up with an even bigger monster.’

Readers' comments (14)

  • Vinci Ho

    I can understand that people would want to ditch these QOF points ASAP provided that the same money would be paid back to practices BUT
    BE CAREFUL that this is a trap or a poison wrapped with sugar coating.
    This government (hence NHSE) can U turn on anything.......

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  • NICE’s proposal to introduce a ‘bundled’ QOF indicator in diabetes next year is ‘unnecessary and misguided’, the GPC has warned.
    Cut and pasted from pulse...
    Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, told Pulse the indicator - announced in a consultation document this week - would penalise GPs striving to do the best for their patients, particularly those working in the most deprived areas.

    Dr Green said he would be responding on behalf of the GPC and would argue that the ‘all-or-nothing’ indicator would hit practices with large numbers of disadvantaged patients known to be difficult to reach for regular check-ups.

    NICE put the indicator out for public consultation, with the aim of suggesting it for the 2015/16 QOF, along with another nine potential new indicators.

    The bundled indicator would see GPs having to carry out eight annual process checks in each patient with diabetes in order to achieve any points, including three annual checks for which indicators were only recently removed from the QOF, namely weight, urinary albumin-to-creatinine ratio and serum creatinine/eGFR measurements.

    QOF is already set to become an even bigger monster. I'll take my chance with a local contract if more nonsense like this becomes reality

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  • Bob Hodges

    Spot on Mike!

    What's happening in Somerset is a time-limited deal. No on us denying practices the chance to do QoF, but the option to do SOMETHING ELSE is a huge step forward. We're fed with bloody London Solutions to non-existent local problems quite frankly.

    Things are on the verge if collapse across the South West (which already as the lowest regional GP income) in terms of workforce. Even Somerset's move might not be enough.

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  • Please believe me when I say that these are not London solutions......
    In London it feels like we are being targeted for more bullying and abuse than anywhere else and morale is terrible here. ( CG appointed to produce " transformation", every practice rung on Christmas and New Year's Eve, total lack of flexibility and frankly a higher threat from loss of practice boundaries and competition from private companies, higher costs of staff and premeses)
    Please don't fall into the divide and rule trap... We are all being shafted.

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  • Predictably national England have publicly supported this, as they had no choice but to go along with this over-riding of a national contract by one of its area teams without prior permission, publicly at least.

    What a joke of an organisation.

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  • Phil Yates

    Well done Somerset LAT. These are not contractual changes (QOF is, after all, voluntary) but a very brave, sensible and insightful solution to the fact that, if NHSE want practice transformation, then GPs need time off the treadmill of unremitting pressure to have the headspace to address the objectives and process.

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  • I agree with Phil Yates. This looks innovative and could act like a template for other less forward thinking
    Or dogmatic regional teams to see what can be achieved by working together.

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  • This of course has absolutely nothing to do with the fact that CQRS isn't working properly and NHS England dont have enough staff (or experience) to cope with QOF!!!

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  • Bob Hodges

    "This of course has absolutely nothing to do with the fact that CQRS isn't working properly and NHS England dont have enough staff (or experience) to cope with QOF!!!"

    That makes this look ever more pragmatic! So NHSE can't monitor it, GPs don't think it does any good. GPs feel that they can use the time to better effect for all concerned, and the money's sitting there. What's not to love about doing something ELSE for the money. I don't think this will mean anyone in Somerset spending even an extra minute with their OWN children, but I can see patients and secondary care REALLY BENEFITTING.

    Pragmatism in the NHS is so rare that I feel that this is the first time I've encountered it since starting medical school in 1994.

    I don't buy the national negotiating postion being weakened. The best people to say what should happen in Somerset are Somerset GPs and the CCG.

    I would be VERY keen for Gloucestershire to follow and offer Somerset our support and cooperation.

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  • QOF has, of course, become a game and may be a distraction but I do think it has lent a structured approach to patient care. For one, the ability to easily locate "missing patients" is extremely helpful in ensuring that target groups receive proper monitoring and treatment.
    Yes, one can quibble with the targeted conditions and ever changing criteria and thresholds but overall, for me, QOF has been "a good thing".
    My present concern is that promises of equivalent funding for other activities and focus will be, as so often before, a smokescreen for longer term reductions in costs. After all, the prime motivation of successive governments has been to get more for less.
    The NHS is no longer safe in anyone's hands. It will soon be The Notional Health Service.

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