QOF is a millstone around the neck of general practice. It should be replaced with a leaner and more responsive animal, says PulseToday deputy editor Nigel Praities.
QOF was a classic New Labour idea. Take a wodge of money away from GPs and give it back to them in the form of performance targets to incentivise them to improve their care.
Initially it worked well for GPs and ministers. Despite the Government of the time despite being surprised by the immediate high performance of GPs, it was able to justify the change as a way of reimbursing GPs who were following evidence-based medicine. Kudos for all.
But then it got complicated. The Government began to introduce questionable targets – such as the much-maligned access targets – and the Daily Mail and others began to run stories about GPs receiving large ‘bonuses’ for routine care. The QOF became a target for lobbying from medical charities and a plaything for PCT managers anxious to micro-manage general practice, and practices started to spend inordinate amounts of time trying to extricate themselves from the tangled mess that is QOF coding.
Even worse, academic research started to be published that showed QOF performance had improved initially, but then began to slide. A recent study on blood pressure shows QOF had little impact on the outcomes of patients with hypertension.
The embarrassed Labour Government started to look at how it could improve the QOF – removing old targets and replacing them with more ‘outcome-focused’ priorities. They gave responsibility for the QOF to NICE, and in characteristic style the institute developed a convoluted and bureaucratic indicator development process.
All you have to do is attend a meeting at NICE to see the QOF machinery in action, with large rooms of well-intentioned experts and their advisers poring over piles of paper and the minutiae of QOF indicators.
With all this, should the QOF monster be put out of its misery? Well I would argue yes, and no.
QOF has created a tabloid newspaper narrative that GPs are playing the system to supplement their income, and this could prove a huge problem for the Government’s commissioning plans once the management allowance is revealed – there is already talk of ‘banker-style’ bonuses from MPs.
But as researchers have said this week, perhaps a better idea is to remove the idea of a centralised QOF and have local versions where consortia can choose what to include in the framework to meet their priorities. It fits with the new Government’s whole localism ideal, and would make the scheme leaner and more responsive (and potentially less of a target).
More than this, it would give consortia another tool to make a real difference to ingrained local health problems – such as sexual health in inner-city Manchester or care home prescribing in Bournemouth, for instance – and that really would be a victory for the beleaguered framework.
Nigel Praities is digital editor of PulseToday