ICBs tasked with performance managing GP practice QOF achievement

ICBs have been tasked with reducing variation in GP practices’ QOF performance as part of a new NHS-wide quality strategy.

The new Quality Strategy for NHS-funded care in England said ICBs will be required to ‘put in place action plans’ to ‘improve contract oversight, commissioning and transformation for primary care and tackle unwarranted variation.’

These plans, which should be put in place this financial year, should improve QOF standards for:

• cardiovascular disease,
• diabetes
• chronic obstructive pulmonary disease (COPD)
• mental health conditions
• dementia

They should also be aimed at ‘increasing the percentage of patients with diabetes who received all eight elements of the diabetes care process bundle’, the document said.

The 10-year strategy, published yesterday by NHS England on behalf of the National Quality Board, says ICBs have responsibility for ‘overseeing the quality of primary care and neighbourhood health services, including holding general practice and wider primary care providers to account for the delivery of high-quality care’.

It said ICBs should use GP contracts and other improvement mechanisms to monitor providers and intervene when concerns are identified.

The document said: ‘ICBs should use contractual and improvement levers to respond and intervene where quality concerns arise, with regional teams providing support where risks cannot be managed contractually.’

NHS England also said data should be used to support ICB boards to ‘routinely review quality in primary care and take action to improve performance and reduce variation’, as well as to hold leaders accountable for delivering improvements.

The strategy said there would be ‘a more consistent approach to monitoring clinical outcomes – at provider, unit and neighbourhood level’ and that boards and leaders would be ‘held accountable for performance’.

However, it stressed that the strategy does not establish a new set of service-specific targets.

It said: ‘This strategy does not introduce a new set of requirements for the NHS or specific targets for particular services, patient cohorts or conditions.’

Instead, it is intended to establish a consistent approach to quality across NHS-funded services over the next decade, based on safety, effectiveness and patient experience.

GP partners will themselves retain formal responsibility for care quality under the strategy.

It said: ‘Boards, executives, practice partners and clinical leaders are ultimately accountable for the quality of care their organisation plans, commissions or delivers, including day-to-day oversight, proactive improvement and responding when things go wrong.’

The document acknowledged that national scrutiny of quality has historically concentrated more heavily on hospital care, despite general practice delivering almost 400 million appointments each year.

It also said NHS England would consider embedding additional quality management and improvement expectations in future GP contract reforms, alongside indicators already incentivised through QOF.

‘We will explore the inclusion of quality management and quality improvement requirements in future GP contracts, building on existing quality improvement activity and quality indicators within the Quality and Outcomes Framework (QOF),’ the plan said.

As part of the quality improvement work, NHS England is developing a series of modern services framework – aimed at reducing unwarranted variation – starting with last week’s cardiovascular framework and a second one on sepsis published yesterday.

The sepsis framework is largely focused on strengthening hospital care, setting out plans to improve early recognition, diagnosis and treatment through standardised pathways, diagnostics, digital tools and research.

Unlike the cardiovascular framework, it contains few immediate proposals for general practice, with GPs featuring mainly in longer-term ambitions around identifying deterioration in the community and future research.

It comes as NHS England recently revealed that more than 100 GP practices in the South East of England were ‘performance managed’ to improve access and reduce variation, as part of a programme laying the ‘foundations for neighbourhood working’.