A number of areas across the country have ditched the QOF – and GPs are already happier.
QOF cover image – January issue
From April, practices in Scotland have stopped working under the framework and all the funding has been put back into their global sum to support moves towards developing GP clusters.
Practices are still expected to maintain disease registers, but are now free to care for patients as ‘clinically appropriate’.
GPs say the move has made treating patients more satisfying and patients are more engaged in their care.Practices are still expected to maintain disease registers, but are now free to care for patients as ‘clinically appropriate’.
In England, a number of CCGs – newly responsible for primary care commissioning – have implemented their own schemes to replace the ‘tick-box approach’ of the QOF.
More personalised care
NHS Dudley CCG has this year developed a ‘quality outcomes for health’ scheme to replace the QOF and the unplanned admissions DES. It aims to make care more holistic and personalised, with fewer targets, named clinical care co-ordinators for patients with long-term conditions and care plans with individualised goals.
For example, the CCG’s clinical lead for older adults Dr Richard Bramble says that instead of giving patients goals such as reducing their BMI to 27, GPs are now working with them to set personal goals, such as ‘to drop a dress size by the time of their daughter’s wedding in six months’.
NHS Aylesbury Vale CCG last year gave practices the option of being paid the equivalent of what they would have earned under selected QOF domains in exchange for better care and support planning. This involves an initial consultation with a healthcare assistant followed by a later GP appointment when patients have had a chance to think about their goals.
The experience of these areas will inform a decision on the future of the QOF across England. The GPC and NHS England have said they will review whether to keep the framework, as well as the unplanned admissions DES, this year, with any changes made from April 2017.
GPC deputy chair Dr Richard Vautrey says: ‘We will be doing that in this year’s contract negotiations, which begin shortly.’
But there is little doubt that the QOF – introduced in 2004 – is on its last legs. Earlier this year, a study in The Lancet showed it was related to a small but not statistically significant decrease in heart disease death rates compared with a slight increase in mortality rates for conditions not targeted in the framework.1
Scotland: ‘I’m a QOF fan but it put a lot of pressure on practices’
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I’m a QOF fan. But I recognise that the QOF was a distraction from the patient’s agenda and put a lot of pressure on practices. That pressure is off and we’re already noticing less work for our managers and admin staff. For instance, recall letters – instead of the required three, we’re sending one annual letter to patients. For GPs, there’s less pressure because we know we’re getting paid without having to demonstrate the quality standards, so we’ve got fewer hoops to jump through.
From a financial point of view there’s more stability because we get paid monthly for what we did previously in the QOF, instead of a balancing payment in June.
Dr Iain Kennedy is vice-chair of Highland LMC and a Highland representative on the Scottish GPC
Buckinghamshire: ‘Removing QOF makes a GP think differently’
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We wanted a wholescale change to a care and support planning approach to long-term conditions. That takes time.
We guaranteed practices their 2014/15 QOF earnings in some areas in 2015/16 plus a 5% uplift so they could relax and not do the box-ticking knowing they would still get the money.Instead, they could concentrate on changing to a care and support planning approach.
We also gave practices a one-off payment of £4,000 that they could use for capacity management, extra nursing time or locums to help them change behaviour.
Practices agreed we could remotely monitor their QOF data at the CCG. There was no reduction in care quality.
As a GP, this approach makes you think differently. You think much more about the patient owning their disease rather than being clinician directed.
Patients are now helping make decisions about their real targets.
Dr Graham Jackson is co-chair of NHS clinical commissioners and chair of NHS Aylesbury Vale CCG, Buckinghamshire
Somerset: ‘I can concentrate on the patient’s real issues’
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My practice of nearly 2,000 patients is one of the most elderly in the UK; 39% of patients are over 65 so there is a lot of work to do. But without the QOF it’s now more manageable.
A lot of QOF activity takes place between 1 January and the end of March – at a time when you are dealing with flu-like illness. The Somerset Practice Quality Scheme – the replacement for the QOF – allows me to concentrate on the patient’s real issues and comorbidities in the best way for them, instead of ticking boxes.
The CCG pays me a quarter of my previous QOF achievement each quarter.
Dr Ian Kelham is a GP in Dunster, Somerset and assistant medical director for NHS England
1 Long-term evidence for the effect of pay-for-performance in primary care on mortality in the UK: a population study.The Lancet 2016; online 17 May.