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GPC: QOF opt-out will let patients down

The GPC has warned that a local deal for practices in Somerset to opt out of the QOF completely will worsen patient care and undermine the stability of the national contract.

The deal – finally given the go-ahead by NHS England’s executive this week – leaves GPs in the county ‘doing no more than many other practices in other CCGs are doing in addition to QOF’ said GPC deputy chair Dr Richard Vautrey.

Pulse has learnt the 80% of Somerset practices have so far signed up to the locally agreed enhanced service, which allows them to stop recording the large majority of QOF indicators while maintaining their current level of income from the QOF.

The final draft of the enhanced service specification says that practices will have to ‘work collaboratively to meet the needs of patients’ and ‘improve communication of patient needs through shared records’ in return for maintaining their funding.

It adds: ‘Practices will work with other NHS and social care agencies at a federation level to develop (and implement where practicable) local plans including pilot proposals, to improve integration between general practice and urgent care services.

‘The plan will include improved communication of patient needs through shared records/ use of special notes.’

This will be measured on a quarterly basis, it adds.

It also calls for practices to ‘work with other NHS and Social Care providers to develop (and implement where practicable) plans (at a federation level) to implement the CCG Long Term Conditions Framework’, which includes ‘personalised care planning for patients with long-term conditions’.

Practices will also be required to develop ‘clear plans to work collaboratively to meet the needs of patients’ with other practices.

Finally, it says: ‘GPs will take a discretionary approach to QOF indicators, based on individual discussion with patients about their needs and aspirations.’

Dr Matthew Dolman, chair of Somerset CCG and a GP in North Sedgemoor, said he was confident practices would continue to deliver high-quality care and insisted the work would lead to benefits for patients.

‘We’re confident as a community that quality will be maintained. The future is how do we manage complex comorbidity and the frail elderly in an integrated way with a workforce that is  sustainable. This is only a framework, we acknowledge that, but the exciting thing is people can learn from it and use it to develop primary care elsewhere.’

Dr Dolman acknowledged GPs in other areas may feel Somerset practices were being let off with less work.

He said: ‘Yes, but we got in there first I guess. It’s a pilot, there’s learning to be had – we’re not saying it’s definitive but we can feed that into negotiations for next year. As we know primary care has got to change – the whole system has got to change – so let’s learn together.’

But Dr Richard Vautrey, deputy chair of the GPC, said he was ‘amazed’ NHS England had approved the enhanced service with no clear measures of the alternative work undertaken and said the specifications amounted to no more than work practices elsewhere are doing anyway, on top of QOF.

Dr Vautrey told Pulse: ‘We have grave concerns about this scheme and wonder whether NHS England have actually read the details. It is no more than many other practices in other CCGs are doing in addition to QOF and other core elements of the national contract…It is extremely vague, it’s very loose and it’s amazing NHS England has actually approved this.’

Dr Vautrey said patient care was at risk as a result of the changes. He said: ‘Patients will suffer – that’s undoubtedly the case. We’ve dealt with the bureaucratic and box-ticking aspects of QOF that were really superfluous and the bulk of what’s left is now clinically appropriate – and supports structured management, so whether you’re in Somerset, Surrey or Suffolk you are going to get the same level of care.’

‘Now NHS England can’t guarantee that and yet they’re supposedly a national body commissioning a service right across the country and I think they are letting patients down.’

NHS England said the plans had been scrutinised ‘rigorously’. A spokesperson said: ‘As you would expect the process and plans have been rigorously scrutinised and evaluated. This is to make sure they are of the highest standard, will deliver on every level including clinical quality as well as wider health outcomes and the organisational development of primary care in Somerset.’