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QOF achievement dropped substantially in 2013/14

Practices’ QOF achievement dropped dramatically in 2013/14, following the Government’s contract imposition that placed a greater burden on GPs, official figures have revealed.

Figures from the Health and Social Care Information Centre reveal that overall achievement reduced from 96.7% in 2012/13 to 92.4% in 2013/14, despite the total number of points reducing from 1,000 to 900.

The number of practices achieving the maximum points available also reduced from 294 in 2012/13 to 162 in 2013/14, reflecting the extra work involved in the contract.

The GPC said that this reduction in QOF achievement was a result of higher thesholds for QOF indicators and the introduction of more difficult indicators.

The report found that the highest domain for achievement was patient experience, where there was an average of 98.5% achievement, while the lowest was in the mental health and neurology domain – which included dementia, depression, epilepsy and learning disabilities – where there was a 89.5% achievement rate.

The GPC had warned that exception reporting would increase as a result of the changes to QOF, and that practices may be forced to focus on patient with health concerns linked to QOF and DES achievement in order to retain its current funding level, leading to reduced access for other patients.

But the latest figures reveal that exception reporting remained at 4.1%, with a 14.4% rate in mental health and neurology.

As part of the contract imposition, the Government raised thresholds of 20 QOF indicators to match the achievement of the top 25% of GP practices, removed £164m in funding from the organisational domain and introducing new indicators recommended by NICE.

The number of QOF points available to practices overall fell from 1,000 to 900 points between 2012/13 and 2013/14, with the loss of the entire organisational domain, money from which was ploughed into four new directed enhanced services – on dementia screening  risk registers for frail older people, remote monitoring and improving access – that were imposed despite GPC objections.

But the Department of Health also imposed several indicator changes in 2013/14  – for example, new indicators on physical activity checks in people with hypertension, referral of people with diabetes for dietary reviews and structured education, and a yearly check on erectile dysfunction in men with diabetes – that were all opposed by the GPC on the grounds they were clinically inappropriate or unworkable.

At the same time, GPs were given less time to carry out reviews, with time frames shortened from 15 to 12 months.

Dr Richard Vautrey, GPC deputy chair, told Pulse the fall in achievement – and loss of income that came from ploughing more resources into achievement – would undoubtedly have been related to the changes enforced by the DH.

Dr Vautrey said: ‘It’s linked to the imposition of indicators many practices felt were clinically inappropriate or not worth focusing on when there were other more important issues to deal with when faced with the patient.

‘There were a whole range of indicators people felt uncomfortable with and were inappropriately imposed. Ultimately this means a loss of income – it’s yet another reason why practices will be struggling financially.’

Dr Vautrey said the reversal of most of these changes for the 2014/15 QOF should mean practices’ incomes will bounce back.

He said: ‘I hope some of the changes we’ve been able to make subsequently will be able to help address that. There were some major changes to some of the imposed indicators and I would hope we’ll see a better outcome for QOF this year as a result.