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Doubts over the future of the QOF as 12 CCGs consider local alternatives

Exclusive At least 12 CCGs are already floating plans to ditch QOF when they become co-commissioners of general practice, Pulse can reveal, with one CCG aiming to implement it as soon as April.

A Pulse investigation of more than 150 plans from CCGs for co-commissioning of primary care – submitted last year – found the CCGs were looking to replace the QOF with incentives to work to the same outcomes as secondary and community care providers or to offer longer appointments to patients with certain long-term conditions, for example.

Local GP leaders are supporting their CCGs in some cases, Pulse has learnt, to give local GPs ‘more flexibility’.

But the GPC warned that GPs, who will still be able to choose whether or not to take part in local schemes, to not ‘be fooled by the superficial attraction’ of these schemes.

The news comes as NHS England revealed in November that co-commissioning CCGs will be given the green light to replace QOF without any central approval from area teams, while GPs in Somerset are already working to a pilot that drops QOF indicators in favour of incentives to form federations and opening up their books for scrutiny among other elements.

Among suggestions uncovered by Pulse’s investigation, NHS Dudley CCG said it was looking to replace parts of the QOF and instead focus on raising standards in one particular patient group.

Chief officer Paul Maubach told Pulse that while the CCG thinks some areas of the QOF are ‘quite useful’, it has been reviewing other parts finding they are covered through other policies, either locally or nationally, including indicators for smoking, arthritis, osteoporosis and sexual health.

He said: ‘We think those areas can be more meaningfully replaced. We’re thinking of having a significant focus on one area. We haven’t agreed this yet but it could, for example, be hypertension.’

In addition, the CCG is currently considering how to merge primary care, secondary care and community care incentives so all bodies work towards the ‘same outcome objective’, Mr Maubach said.

NHS Dudley CCG is hoping to start the ‘first stages from 1 April’, Mr Maubach said.

NHS Aylesbury Vale CCG is floating similar plans, hoping to overhaul QOF to instead incentivise ‘significantly more care to be undertaken out of hospital’.

Chief officer Lou Patten said: ‘In order to achieve this, we need to align all commissioning intentions and contracting incentives. We are currently looking at specific projects, such as diabetes and our locality-led over-75s projects, to see what further improvements we could deliver if there was some alignment of GP incentives instead of the QOF.’

NHS West Hampshire CCG is also looking at merging incentives across different systems, including for example GPs offering longer appointments for certain long-term conditions.

CCGs considering local QOF replacement schemes

NHS Aylesbury Vale CCG

NHS Dudley CCG;

NHS Eastbourne, Hailsham and Seaford CCG;

NHS Gloucestershire CCG;

NHS Hastings and Rother CCG;

NHS High Weald Lewes Havens CCG;

NHS North Somerset CCG;

NHS Redditch and Bromsgrove CCG*;

NHS South Worcestershire CCG;

NHS St Helens CCG;

NHS West Hampshire CCG.

NHS Wyre Forest CCG.

CCG chair Dr Sarah Schofield said: ‘What we might be interested in saying is, GPs need half-hour appointments with patients who have specific long-term conditions, and they would have to do that, say, three or four times a year.’

Dr Ivan Camphor, secretary of mid-Mersey LMC and a GP on the Wirral – where the local CCG is looking to drop the QOF – says: ‘There is no doubt in my mind that the QOF, or a large proportion of it, will be replaced. I think it is going to help practices because the QOF can be quite rigid, whereas if you have local flexibility you can address needs in a more comprehensive and holistic manner.’

However, the plans have been greeted with skepticism by the GPC, with deputy chair Dr Richard Vautrey warning that ‘GPs should not be fooled by the superficial attraction of moving away from the QOF’.

He added: ‘The reality is, this will increase workload, not reduce it, as data linked to each QOF indicator would continue to be extracted from GPs’ IT system and they’d still be performance managed against it, while at the same time expected to do even more work, paid for by the small amount of money that was funding the QOF.’

NHS England announced in November that CCGs applying to take ‘delegated responsibility’ for primary care commissioning would have the option of ditching the QOF and introducing a local incentives scheme in its stead. The deadline for applications for CCGs wishing to take this responsibility is in January.

*Dr Jonathan Wells, chair and clinical lead of NHS Redditch and Bromsgrove CCG said: ‘As part of the expression of interest for co-commissioning submitted in June 14 the CCG stated that “we would wish to actively work with practices on developing and delivering local quality standards, as a potential replacement for the national Quality and Outcomes Framework”. No further work has been done on this to date and no discussions have yet been held with membership practices. I am personally very cautious about abandoning the QOF.’

Please note: This article was altered on the 27/12/14 to add in a quote from Dr Jonathan Wells from NHS Redditch and Bromsgrove CCG to clarify that since the preparation of their expression of interest in co-commissioning, no further work has taken place on any plans to replace QOF in his region.