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GP practices may have missed out on ‘thousands’ through QOF last year

Practices are expecting to miss out on thousands of pounds in QOF money for 2019/20 they had originally been budgeting for, despite an adjustment to mitigate the effects of Covid-19.

NHS England has committed to topping up QOF funding for 2019/20 if practices earned less than the previous year because they had turned their focus to the pandemic in March, when they would have been finishing QOF requirements for the year.

But the BMA has clarified to Pulse that they will only match cash funding, and not points earned, which means the majority of practices will not benefit from the uplift in funding announced last year.

While the size of QOF remained unchanged for 2019/20 at 559 points, the value of a QOF point increased from £179.26 in 2018/19 to £187.74.

GPs warned many practices will miss out on the extra cash from the points uplift because GPs tend to make a ‘big push’ on QOF work at the end of the financial year, but QOF work will have stopped for most because of the pandemic.

This could be particularly acute for practices whose list size increased the previous year.

Swindon GP and QOF expert Dr Gavin Jamie added: ‘Keeping the cash value the same would have an effect on practices that might be small in percentage terms but is likely to be into the thousands, depending on practice size.’

He added: ‘Actually the bigger problems with that approach are likely to be around changes in practice. If the cash value is the same but a practice took on a lot of patients then they would be underpaid. If they lost a lot of patients then they would be overpaid.’

A ‘point for point’ income protection would automatically allow for practices getting bigger or smaller over the year, Dr Jamie told Pulse.

Michael Ogilvie, an accountant at X5 Chartered Accountants, said the QOF payments are ‘a real mess’ and that ‘nothing would surprise [him] in the current chaos’.

He told Pulse: ‘What I understand was promised was that no surgery should suffer because of changes caused by Covid-19 and that income limits will be at least maintained to 18/19 levels.

Mr Ogilvie added that his advice to practices is to ensure all claims are made ‘in as detailed a manner as before’ so they are ‘paid the money they had earned’.

Dr Mike Smith, a GP partner in St Albans, told Pulse his practice’s QOF payment for 2019/20 will ‘undoubtedly’ be low compared to what it would have achieved without coronavirus having hit.

He said: ‘It’s enough to make us worry. It’s largely due to the fact that there’s an assumption that QOF is something that you achieve at the same rate all year, when actually everyone who works in general practice knows that there’s a big push in the last quarter and that’s traditionally how the model has gone.’

He added that he is ‘disappointed’ at the lack of ‘imagination’ in adapting QOF to the pandemic and the ‘very poor’ calculation to make up for lost time.

He said: ‘There has been no recognition in QOF to try and adapt to that in terms of points on remote type monitoring [or] adjustments in terms of what meaningful things we can do within our power in the practice.’

He added: ‘There’s just been no imagination or planning in terms of working this forward – literally they’ve switched it off and switched it back on again with a very poor calculation for the pause in service.’

In March, NHS England announced it would make a ‘one-off adjustment’ for practices who earn less this year as a result of coronavirus activities, following an analysis of the pandemic’s impact.

As well as the top-up payment offered to practices, NHS England said in March that practices will receive automatic payment for certain 2019/20 QOF targets. 

It comes as GPs will have to work harder for QOF income in 2020/21 as protected points have been reallocated so that practices concentrate on expanding flu vaccinations and catching up on cervical screening.

But nearly 60% of GPs have found immunisation uptake to be down this year compared to last, Pulse revealed.

And NICE recommendations for GPs to refer a quarter of all patients for weight management services could be added to QOF by next year.

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