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Revealed: Huge administrative challenge of new QOF efficiency targets

By Lilian Anekwe

GPs have warned the new 'quality and productivity' indicators will present a major challenge to practices as the complex requirements of the targets were released.

For the prescribing indicators, practices have have just three months to agree three areas of improvement with their PCO and also will have to submit detailed reports on how they have reduced emergency admissions and referrals within less than a year to NHS managers.

The new indicators - worth nearly 100 points - were agreed as part of the new GMS contract negotiations for 2011/12 that offered practices no new money. Patient experience and other process indicators were retired, but new QOF indicators were introduced to encourage GPs to make efficiency savings in three areas – prescribing, secondary care outpatient referrals and emergency admissions.

The wording of the indicators - published by NHS Employers this week - runs to eight pages and is likely to become an administrative headache for GP practices as they involve agreeing areas to focus on with managers, carrying out an external peer review, monitoring progress and producing reports detailing their results. Read the full guidance here.

A survey of 200 GPs carried out by Pulse before the final wording of the indicators was released, reveals three-quarters thought redesigning care pathways using QOF indicators was 'not feasible'.

The guidance makes clear that practices must internally review their prescribing to assess its clinical and cost effectiveness, including examining data on the ‘prescribing of drugs available generically and information about the costs of drugs actually prescribed and clinically suitable lower cost alternatives', and then agree with their PCO three areas for improvement ‘in writing no later than 30 June 2011'.

Practices will then be paid on the basis of the percentage of prescriptions complying with each of the three agreed plans as a percentage of all prescriptions issued in that ‘improvement area' between 1 January and 31 March 2012.

Achievement will then be measured ‘against a sliding scale', with the maximum percentage set locally. The guidance states this ‘should normally be set at the 75th centile of national achievement' as at 31 December, but could be set lower if locally agreed between practices and PCOs.

The minimum threshold, representing the start of the scale and with a value of zero points, should be set 20 percentage points below the maximum threshold, the guidance states.

PCOs have been ordered to give practices a monthly progress report from October, and the guidance encourages managers to keep close tabs of prescribing rates and cost-effectiveness down to the level of the individual GP ‘where possible'.

Practices will not be penalised if others in their group fail to bring down the costs of their prescribing, but it will not be possible to exception report patients from these indicators.

GP practices, in groups of at least six local practices, will also conduct external peer reviews of secondary care outpatient referral data ‘to determine why there are any variances' and ‘propose areas for commissioning or service design improvements to the PCO', with an emphasis on care pathways for patients with long-term conditions.

It is expected PCOs will lead the development of care pathways, working with practice groups and the LMC, but all practices must submit a report to their PCO set out ‘the changes in patterns of referrals that have resulted', by the end of March 2012.

For the indicators relating to emergency admissions – defined in the guidance as ‘admissions that are unpredictable and at short notice because of clinical need' – practices must also conduct internal meetings with all practice clinical staff and external reviews to compare rates of emergency admissions with other local practices, agree three new care pathways to avoid emergency admissions, and produce a report of the changes to emergency admissions rates by April 2012.

Read the full guidance here.

QOF guidance 2011-12 GPs will have to prove they have reduced emergency admissions