Practices dropping QOF 'did not lead to reductions in quality'
A new quality improvement scheme set up in Somerset to replace the QOF has been beneficial for both GPs and patients, an independent evaluation of its first year has concluded.
The report found that dropping the QOF has freed up GPs to offer patients more holistic, person-centred and co-ordinated care – without any reduction in measures of quality.
GP commissioning leaders said the findings were ‘positive’ and showed the benefits of giving CCGs freedom to transform care locally.
But the GPC warned such schemes still had the potential to create even more workload and bureaucracy for practices in the long run.
NHS Somerset was the first to be given the go-ahead to run a one-year pilot of the scheme – termed the Somerset Practice Quality Scheme (SPQS) – in June last year.
Several CCGs have been closely following its progress after NHS England said they would be allowed to follow suit under co-commissioning rules and NHS England advisors said the Somerset experiment could offer the blueprint for similar schemes.
The 55 practices that took part – out of 75 in the area – were allowed to drop reporting of all but a few ‘core clinical’ QOF indicators.
In exchange, they provided reports on how the funding has been used to improve local services through integration of general practice with urgent care services, offering more personalised care and building practice sustainability.
The final report from an independent evaluation of the pilot – conducted by health policy experts from the South West Academic Health Science Network (SWAHSN) – said that while QOF achievement dropped there was no difference in data for outcomes on clinical measures such as cholesterol and HbA1c when comparing practices in the SPQS with those that stayed in the QOF.
GPs and nurses reported being able to treat ‘the whole person’ and have longer appointments, while patients said they were more involved in decisions about their care and needed to visit the practice less often.
The SWAHSN team concluded that on the basis of their findings, extension of the pilot would be beneficial.
The report stated: ‘Given the promising qualitative data, the genuine passion for SPQS that we encountered, and if the above recommendations were considered suitable by key stakeholders, we would consider SPQS phase 2 an exciting prospect for further service development.’
The Government is now planning to introduce a new voluntary contract from 2017, for federations of practices offering seven-day access, that could involve dropping the QOF – although health secretary Jeremy Hunt has indicated GPs would still need to report on QOF indicators.
However, CCGs may still be looking to follow the Somerset model in the meantime through co-commissioning.
Dr Amanda Doyle, co-chair of NHS Clinical Commissioners, chief clinical officer at NHS Blackpool CCG and a GP in the town, said the latest report showed ‘some interesting results’ and highlighted the importance of giving CCGs and their local partners the ‘freedoms and flexibilities that they need to transform healthcare for their local people’.
Dr Doyle said: ‘This scheme in Somerset is a positive example of an area being given the freedom to do just that.’
Dr Richard Vautrey, deputy chair of the GPC, said the report ‘confirms that if GPs are given the time and resources they will deliver a more patient-centred holistic care rather than focus on box-ticking in order to secure essential practice funding’.
However, he said that practices should ‘be wary about local CCG co-commissioning schemes that simply take QOF funding and use it to create more workload and bureaucracy for practices with it’.
He added: ‘The funding in the QOF is essential for practices to maintain their current level of service to their patients and should not be removed just to be added back with even more strings attached.’