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CCGs to be given green light to agree local QOF deals



CCGs will be allowed to replace the national QOF agreement with their own locally agreed deals without NHS England approval, under new proposals announced by NHS England today.

In its board papers, NHS England opened the door for regions across the country to develop their own deals, similar to that announced in Somerset last year, as part of its plans to allow CCGs to ‘co-commission’ primary care.

Under the proposals, which will be finalised at the board meeting on Thursday 6 November, GPs will still have the right to continue with the nationally agreed QOF deal, regardless of whether their CCG has introduced a local deal.

The Proposed next steps towards primary care co-commissioning document sets out the parameters around what areas of primary care CCGs will be able to commission, after NHS England chief executive Simon Stevens outlined plans earlier this year to give commissioning groups greater responsibility.

As part of the proposals, CCGs will be able to take on responsibility for procurement of new practices.

It also proposes that the committees responsible for co-commissioning within CCGs must not be chaired by clinicians, and must not have a GP majority in an attempt to manage potential conflicts of interest.

The proposals on locally negotiated quality programmes would allow CCGs to establish a regional scheme without NHS approval, though it recommends ‘any CCG who wishes to develop a local incentive scheme is expected to first consult with the Local Medical Committee’.

The proposals would open the door for more regions to deviate from national arrangements, as currently being piloted in Somerset where two-thirds of practices opted to drop the QOF.

The paper states: ‘At present, NHS England has policies in place to ensure national sign-off on any variation to national incentive schemes. However, the introduction of co-commissioning brings in local partners – CCGs – and offers them the opportunity to take on the decision-making and responsibilities of primary care commissioning, either jointly with NHS England, or independently, through delegated commissioning arrangements. The purpose of primary care co-commissioning policy is to enable clinically led, optimal local solutions… we are legitimising CCGs being able to make these decisions without them needing to go through a case by case approvals process.’

It adds: ‘Under delegated arrangements, CCGs would have the ability to offer GP practices the opportunity to set the strategic direction for quality by providing a locally commissioned service or participating in a locally designed incentive scheme.

‘This is without prejudice to the rights of practices to their GMS entitlements being negotiated and agreed nationally.

‘Any migration from a national standard contract to a local contract could only be affected through voluntary action.’

The GPC has previously urged caution over local schemes, saying it could have the ‘unintended consequence, of GPs doing the same work, for less resources, and then having to work hard to earn that resource back.’

Dr Richard Vautrey, deputy chair of the GPC, told Pulse today: ‘In many ways, it’s just reinstating the powers that PCTs had over contracts. And it’s yet another sign of the direction, moving back to PCTs, that we’re seeing as NHS England devolves responsibilities.

‘I think the key thing is whether CCGs exert that power, and whether practices want that, and whether there is genuinely a relaxation or push from the centre. That’s what we didn’t see with the Department of Health and PCTs previously, that’s why – despite their ability to do so – PCTs didn’t abandon QOF in any significant way, although they had the powers to do so.’

Dr Mike Dixon, chair of NHS Alliance, said it was an ‘excellent’ development.

He said: ‘It seems to me increasingly, GP remuneration is going to be a mix of local and national, I think the QOF has become too inflexible, and too often a question of point-scoring and tick-boxing. And I think that’s excellent, that’s completely the way forward. That’s what Somerset’s done is what now needs to happen elsewhere if people want it.’