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Smaller QOF being considered under radical rethink of GP contract by NHS England

Exclusive NHS England are considering radical proposals to scale back the size of the QOF to free up resources for more ‘creative’ ways of incentivising GPs to improve patient care, says the new head of primary care commissioning.

In an exclusive interview with Pulse, Dr David Geddes said that the proportion of funding tied to QOF was currently ‘quite large’ at around 17% and that he was considering working with NICE to reduce it.

The move comes as NHS England prepares for a major shake-up of practice funding with a new primary care strategy to be published this autumn.

Dr Geddes, who is also a part-time GP in York, said that NHS England was currently consulting with CCGs, the RCGP and the GPC and that he expected the strategy to include ‘more creative’ ways of incentivising GPs to work towards ‘outcomes rather than processes’.

He also said that the body also would like to move away from annual reviews of the GP contract, in favour of developing a ‘flexible contract’ that could be better applied more locally.

He said that GPs required more ‘head room’ to provide preventative care, and that they were going to ask NICE to rationalise QOF to remove indicators that are not evidence-based or link with outcomes.

Dr Geddes said: ‘I think we have to recognise that QOF has played a part in achieving quite a lot over the years but it may not necessarily be the vehicle by which we continue to invest or to change clinical priorities.

‘It is really an opportunity for us to work with NICE to be able to decide which of the QOF indicators are most useful and most evidence based and most likely to be able to produce that change.

‘QOF counts for around 17% of practice income which is of course a large amount and it may well be that we wish to look at having a different mechanism for commission for some of those enhanced areas of care without it having to be through the QOF process.’

He added that NHS England recognised that GPs needed the freedom to develop a more preventative health service by removing some of the more ‘tick-box’ elements of the contract.

He said: ‘We need to be creating some head room and space for other doctors who are busy and who need to be supported in being able to provide a different sort of service.’

Dr Geddes added that the strategy could also remove the need for annual contract negotiations: ‘There are areas of the contract that will no doubt have to be discussed, but we want to be able to agree a plan, going forward, and then see how that will evolve over a period of time.

‘We need to be able to find a flexible kind of contract which gives us that approach forwards, so we have that agreement where we are headed. It will be part of a broad dialogue for the vision of what primary care will deliver in the future.’

As part of that vision, Dr Geddes also said that they were looking at changes to the GP contract to enable local area teams and CCGs to jointly commission services with one standard contract across primary care, secondary care and community services if it was needed to join up care.

GPC deputy chair Dr Richard Vautrey warned that GPs were weary of constant change to their contract, but that they would consider any proposals.

He said: ‘This appears to be a major change to the GP contract at a time when practices are worn down by constant change that simply adds more work and takes away funding.

‘I am sure that NHS England is hearing this message loud and clear from their discussions with other bodies and it is something that cannot be ignored.

‘We will discuss any proposed changes with NHS England as part of our regular negotiations but they should be under no illusions as to the severe and unsustainable workload pressures practices are currently experiencing and any future contract changes must primarily address this.’

Professor Clare Gerada, RCGP chair, said any move to reduce GPs’ QOF workload would be ‘wonderful’.

She said: ‘What I think they are talking about is targeted care where those who need it most are given longer consultations to help improve continuity and decrease fragmentation. That would be good.

‘What the college is saying is we need more GPs spending longer with their patients, with longer training. Anything that frees up GPs to spend longer with their patients, and help to improve continuity, will reduce hospitalisation, which is what we need.’

Readers' comments (17)

  • new local incentivised guidlines responding to needs / health dermographics of local population. Why nor call if PMS ,catchy or what?

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  • I just hope this comes to fruition. GPs are so bogged down by QoF we just dont have time to be move effectively into the world of devising & commissioning new and effective practices.

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  • Vinci Ho

    (1) QOF was created with a principle of practising some evidence based medicine in 2004 . Since then , how did the history progress? More and more tick boxes were added in without support of genuine evidences ,e.g. screening depression in chronic illnesses, the new GPPA questionnaires in hypertension . QOF in fact became a 'convinient ' portal for academics and politicians to extract so called essential datas for them.
    (2) What you wish and what you will get is a completely different matter . Of course, we need to be open mind about this rethinking of QOF but does NHS England really have the sincerity to help GPs with these 'creative' changes?? Any other agenda? RCGP and BMA have to be very careful . Your obssession of making things better can be very easily exploited by politicians ...
    (3) For those who are old enough, remember the red book? Life just goes with circles , doesn't it?
    (4) Ooops! Is this opinion reasonably taken to represent the profession more widely???? My bad otherwise....

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  • So in effect they are talking about reducing QOF income but expecting GPs to still do the work (wich NICE and CQC will insist on) with no income and do extra new "outcomes" work with the old QOF money.
    Someone at the BMA needs a large testosterone injection.

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  • Daryl Mullen has got it in one. It would also appear this will be how they will finance the new OOH commitment in much the same way as the extended hours. Quelle Surprise!

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  • Dont agree with the above. Why as GP practices are we undertaking QoF preventative medicine, most of which is number crunching and could be done with nurses or other trained staff. This type of work we could commission others to do whilst we commission and pay ourselves to undertake the management of complex cases i.e the medicine that we actually were taught in medical school. Through commissioning we could bring back more Cottage Hospitals and once again go back to treating patients hand on and being paid to do it etc etc. We need to think about commissioning as a way of controlling what we do, how we or others do it and ultimately pulling money (back) into primary care. If we dont change Virgin Health etc will destroy us.

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  • @Anonymous | 15 May 2013 11:27am:

    I'm afraid I agree with Daryl Mullen and disagree with you. QOF money is treated as "extra" funding by the media and a yard stick to beat us with by politicians.
    In reality it is part of our "core funding" as most practices couldn't survive without that income.
    I'm also not sure about QOF income only forming 17% of practice income... anecdotally it is higher than that.
    If any QOF money is taken away practices will be irrevocably destabilised without taking on additional work... hence the conveniently engineered OOH debate!

    Initially I thought we would be stuffed by being forced to take on OOH for an additional 6% income (as originally deducted in 2004) or have our practices go to the wall... I now feel we are being set up to take back OOH for no extra funding at all by simply recycling current QOF income into new ventures.

    Taking back OOH would be a mistake in any form... OOH care was underfunded before 2004 and will be underfunded afterwards. The only difference will be who pays the OOH bill for the nation. Discussion about GPs setting up social enterprises to take on OOH is all very well... but if those companies cannot pay GPs what the market demands for unsociable hours they will not have a workforce. If that happens the responsibility is back on GPs to provide the service or take a further personal pay-cut to pay market rates to GPs willing work at night.

    The future is not bright... and it definitely isn't orange.

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  • QOF has to go.There was never any strong evidence base behind it and not surprisingly hasn't translated to any meaningful reduction in disease burden in the country.It has engendered a tick box culture which alot of us hate.However the real question is what we get imposed on us in its place

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  • It would be so much simpler and cheaper for the government if we could all be employees.Why are we such a pain in the ass!

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  • QOF represents what? about 17% of income to practices. This year they shaved off 10% of the cash and then offered it back but only if we complete 4 new DES's at our cost.

    A slashing of QOF and reduction in income will be just that. Getting asked to do more work to earn it back will simply add more burden and we would be brave not to agree. Its a pay cut, dressed in patient benefit speak.

    Whilst we are well paid and enjoy professional lives this continual erosion is going to lead to more stress more work and as commentators above have pointed out an acquiescence on accepting OOH back as it is the only way we can have any hope of preserving even 60% of our incomes.

    Dont think many older GPs will hang around for that much longer. NOt sure re new GPs, anyone tried recruting recently?

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