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Some practices ‘could lose income’ as QOF flu payments move to PCN DES, GPs warn


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GP leaders have warned some practices could lose income when the four flu indicators in QOF being retired and replaced with new incentives in the Investment and Impact Fund (IIF) from April.

Recent NHS England QOF guidance for 2021/22 said that four flu-related indicators will be retired from April 2021, totalling 18 QOF points.

The ‘rationale for retirement’ is that ‘incentives to support seasonal influenza vaccination coverage will be in the IIF from 2021/22’, it added.

A letter summarising the changes said: ‘The four flu indicators have been retired with incentives relating to flu vaccination for target groups being introduced in the Investment and Impact Fund.’

Lincolnshire LMC medical director Dr Kieran Sharrock said some practices could lose income if PCN flu uptake as a whole is lower than that of the individual practice.

He told Pulse: ‘The risk with it is that it disadvantages practices in PCNs who have difficulty getting patients to have their vaccine – that’s more likely to be deprived areas’.

Practices in deprived areas find it more difficult to recruit both staff to deliver the vaccines and patients willing to be vaccinated so it ‘adds to the inequalities’, he said.

Dr Sharrock added: ‘One practice may have been in a slightly less deprived area and therefore achieved the targets required but across the PCN, one or two deprived practices could bring the whole PCN down and therefore disadvantage everybody.’

And Dr Gavin Jamie, a QOF expert and a GP partner in Swindon, told Pulse this could lower the incentive for practices to achieve high uptake with the flu programme.

He said: ‘QOF had about 18 points in a normal year for flu and QOF pays in cash to the practice. They doubled the points through the course of the year so it’s going to be an even bigger change. The IIF is not really money you see and that will depend on how your PCN is run.

‘To my mind, it reduces the incentive to invest in flu uptake. There is still the item of service fee but this year, staff came in on a Saturday and we paid overtime and there’s going to be less return on that.’

For Dr Jamie’s practice, which is not a member of a PCN, the funding ‘just disappears’, he added.

Earlier this month, NHS England said ‘no further’ IIF indicators will be introduced until 1 October 2021 ‘at the earliest’ – alongside the four new PCN service specifications due to be introduced this year.

It said: ‘IIF indicators on seasonal flu vaccination (including for over 65s, patients aged 18-64 in a clinical at-risk group and children aged two to three years), annual Learning Disability Health Checks and Health Action Plans and social prescribing referrals will continue for 2021/22, alongside a further indicator to support the implementation of national appointment categories.

‘No further IIF indicators will be introduced until 1 October at the earliest.’

It comes as GPs will be expected to restart all QOF activity from next month, as QOF payments will not be protected beyond the end of March.

Meanwhile, NHS England this week announced the ‘incredible success’ of this year’s flu programme, with four million more patients vaccinated compared with last year.

An email bulletin sent to practices on Tuesday said: ‘General practice and community pharmacy teams have given the flu vaccine to over 19 million people – that’s over four million more than last year.’

Last year, the introduction of the PCN incentive scheme was delayed due to the pandemic, with the money redistributed elsewhere.

But in September, NHS England confirmed the IIF would be fully rolled out from the following month.

Meanwhile, it was revealed last week that GP practices will not be able to exclude any eligible patients when reporting against the new childhood vaccinations and immunisations QOF indicators that come in from next month.

Additional reporting by Emma Wilkinson

Flu indicators being retired from QOF from April 2021:

COPD007: The percentage of patients with COPD who have had influenza immunisation in the preceding 1 August to 31 March (6 points) 

DM018: The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August to 31 March (3 points)

STIA009: The percentage of patients with stroke or TIA who have had influenza immunisation in the preceding 1 August to 31 March (2 points)

CHD007: The percentage of patients with coronary heart disease who have had influenza immunisation in the preceding 1 August to 31 March (7 points) 

Source: NHS England