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GP contract to be carved up under radical plans to pool QOF and DES funding

Exclusive CCG leaders are preparing radical plans to split the national GP contract and take control of all QOF and directed enhanced service funding, Pulse has learnt.

The plans would pool all non-core contractual funding and CCG primary care budgets in order to create a much larger ‘local QOF’ or dedicated fund to improve patient care, CCG leaders in one region have told Pulse.

Pulse has learnt that CCGs in various parts of the country are enthusiastically taking forward NHS England chief executive Simon Steven’s recent call to submit ideas on how area teams and CCGs can ‘co-commission’ GP practices.

Several CCGs are already in the advanced stages of developing plans on how they can take more control of primary care before the deadline to submit plans on the 20 June.

However, other CCGs have decided they will not apply to co-commission primary care as it would ‘risk the relationship’ with member practices.

The GPC criticised plans to pool GP contract funding, saying there are ‘inherent risks’ for practices, following last month’s LMCs Conference vote rejecting plans for CCGs to co-commission primary care.

The plan to pool all non-core contractual funding by NHS West Hampshire CCG goes much further than the plans from NHS Somerset CCG to opt out of the QOF, with enhanced service, QOF, Better Care fund and the £5 per head of population funding supporting the unplanned admissions DES all being combined to tackle local priorities.

NHS West Hampshire CCG vice clinical chair Dr Nigel Sylvester, a GP in Winchester, told Pulse that the fund would allow the CCG to ‘be much more creative’.

He said: ‘All the enhanced monies will be coming to us in one way or another so if you could pool them and look at what you could do locally, that is a much more creative way of using the money rather than being straight-jacketed by sort of the national requirements.’

He added: ‘There’s the Transformation Fund, the Better Care Fund and co-commissioning, that will allow pooling of money, if you like, and that will enable us to look at the older population, the vulnerable population, those with long-term conditions in a much broader way, rather than all the money being in silos and being unable to move the broader agenda on.’

‘So when it comes to QOF, for instance, from my point of view – and the LMC would disagree with this – taking the QOF money as they have in other CCGs, and putting that into a fund, or having a local QOF, would be very exciting. Because we have got some very creative GPs out there who want to do exciting things, and under the current regulations it is difficult to enable them to do that.’

Asked whether it could be similar to Somerset where the CCG is looking to commission an alternative to QOF, Dr Sylvester said: ‘Indeed. That is absolutely it, yes. It will allow us to look at that.’

Other CCGs who have so far shown interest in co-commissioning include NHS Bristol CCG, NHS South Warwickshire CCG, NHS Northern, Eastern and Western Devon CCG and NHS Norfolk CCG.

Board papers from NHS Hammersmith and Fulham CCG reveal that eight CCGs have been earmarked by NHS England to trial a new ‘co-commissioning arrangement’ in primary care that would enable them influence funding changes, such as the MPIG phase-out and PMS reviews.

The paper says: ‘Co-commissioning could provide North West London with the ability to influence these initiatives as they develop, so that they support the transformation required for Whole Systems of Integrated Care.’ 

By contrast, NHS Norwich CCG chief executive officer Jonathon Fagge said in public board papers that the CCG would not be bidding for co-commissioning, as the CCG did not have the ‘necessary resources to discharge this function to an acceptable standard’.

He added: ‘There would be a risk that the positive relationships between the CCG and its member practices would be undermined if the CCG took on contract and performance management of its members.’

Dr Nigel Watson, chair of Wessex LMCs, which covers Hampshire, said he did not agree with the plans to take over QOF funding.

Dr Watson said: ‘I wouldn’t get rid of QOF and give that to the CCG to commission. Again my view has been the same as for the Somerset scheme as regards QOF – that we need a national contract so that everybody is entitled to the same service, but we need some local flexibility.’

Dr Beth McCarron-Nash, a GPC negotiator, warned that plans to co-commission primary care could create risks for practices.

She said: ‘What’s a real shame is CCGs are just over 12 months old and instead of focusing on commissioning appropriate secondary care services they are champing at the bit to come up with local contracts.

‘I would argue practices need to be minded QOF and other similar funding streams are ways of ensuring funding goes into practices to deliver quality markers – and if you take away that funding mechanism, don’t think for a minute practices won’t be challenged on the quality of care they are providing and be contract managed through other routes.’