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GP consortia ‘should develop local QOFs’

By Lilian Anekwe

Researchers have urged future GP consortia to consider implementing local QOFs as a means of improving the quality of patient care and reducing health inequalities.

The GP academics behind an innovative QOF+ scheme currently running in one London PCT say reviving the idea of local QOF schemes could help GP consortia ‘focus their attention on local health needs'.

Local QOFs were first suggested by former health minister Lord Ara Darzi in the NHS Next Stage Review in 2008, and in its response to the consultation on these proposals the NHS Confederation argued they would like to see around a third of QOF targets to be decided locally.

A Pulse survey in February 2009 found one GP in seven said they were working under a local QOF scheme, and just over a third of GPs backed the previous Government's proposals to introduce local incentive schemes.

The idea has not been actively pursued by the current Government, but writing in the BMJ, the authors encourage say the NHS reforms offer an opportunity for the schemes to be revived and GP commissioners to consider implementing local schemes where possible.

A handful of PCTs have implemented local QOF, the largest of which, the QOF+ scheme, is running in NHS Hammersmith and Fulham and was developed in partnership with academics at Imperial College London.

The QOF+ scheme was launched in September 2008 and will cost £2.2m over five years – 52% of the local annual spend on the national QOF – for an area with 180,000 patients at 32 general practices and two acute hospitals.

Under the QOF+ scheme, practices can earn an additional 29 points, or £3,625, if 90% of patients with hypertension reach the treatment target of 150/90mm Hg or lower. Under the national QOF, GPs earn 57 points, or £7,125, if 70% of patients reach the target.

Professor Azeem Majeed, professor of primary care at Imperial College London and a GP in Clapham, south London, wrote: ‘Although management capacity to develop local schemes may be further eroded by the abolition of primary care trusts, the formation of general practice consortiums means that the scope for clinical engagement in such schemes will increase.'

‘Our experience suggests that current reluctance to set up local incentive schemes may result in missed opportunities to improve quality, encourage innovative service development, and tackle local health priorities.'

Pros and cons of local incentive schemes

Potential advantages
- Can set and reward more ambitious targets
- Opportunity to pilot new indicators before national roll-out
- Promotes GP ownership of the quality agenda
- Incentives can be targeted tor reflect local needs
- Potential to reduce health inequalities

Potential disadvantages
- Consortia may lack the IT infrastructure to commission local schemes
- Variations in healthcare may increase
- Potential for unintended consequences
- Cost of buying in financial, technical and human resource requirements

Source: BMJ, published online 24 January 2011

GP consortia 'should develop local QOFs'