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GPs told to continue working on retired QOF indicators to ‘demonstrate good patient care’



Exclusive GPs have been told by NHS managers that they are ‘required to’ continue providing services that were dropped from QOF as part of this year’s contract negotiations to demonstrate ‘ongoing delivery of good patient care’, a claim that has been rubbished by the GPC.

An email from the Health and Social Care Information Centre (HSCIC), distributed via NHS England local area teams to practices, said that practices had to agree to data relating to 24 retired indicators being extracted by 23 January to prove that they ‘continue to provide the services linked to these indicators’.

The indicators, which were scrapped for the 2014/15 GP contract, include a direction to use the criticised GPPAQ questionnaire to ascertain exercise levels in patients with hypertension, as well hypertension blood pressure targets that had been criticised for risking overtreatment of patients.

As part of the contract, NHS England said it would ‘continue to collect and publish data, as far as possible, on the relevant interventions and outcomes in order to support practices in promoting ongoing quality improvement’.

However, the GPC has strongly disputed that this would involve continuing to provide these services to the same extent, and has issued a warning note to all practices informing them that the email from HSCIS and and local area teams is inaccurate.

There is no indication about how NHS England will enforce this, but the GPC said there was an ‘anxiety’ that the data would be used to measure practice performance similar to the CQC’s ‘intelligent monitoring’ data and that it could be used by CCGs looking to implement their own local versions of QOF.

The note from HSCIC, sent to all GPs, said that the funding had been removed from QOF and put into the global sum, but the services still needed to be provided.

The document said: ‘The indicators included in this customer requirement were previously included and funded through QOF 2013/14. These indicators have been retired from QOF and payment has transferred to the core GMS contract for payment through the global sum.

‘It is a requirement for general practices to ensure they continue to provide the services linked to these indicators. This data extraction will help inform commissioners that general practices are continuing to do this, demonstrate their ongoing delivery of good patient care, and provide statistical information.’

However the GPC said that they had only agreed for the continued extraction of the data linked to the indicators, not for the practices to do the work.

In a warning note to practices, the GPC wrote: ‘GPC has heard a number of understandable concerns regarding recent communications from [HSCIC] about retired QOF indicators for 2014/15… HSCIC suggests that “it is a requirement for general practices to ensure they continue to provide the services linked to these indicators”. This statement is incorrect and is not what was agreed by GPC, NHS Employers and NHS England in the 2014/15 contract negotiations.’

It added that the GPC ‘anticipates a large fall in the recording of many of the retired codes’ as practices ‘now work more appropriately’.

GPC said it was especially concerned about the wording of the document in light of the CQC’s recent use of QOF performance and patient survey results to publicly band GP practices into ‘risk rating’ categories.

It wrote: ‘Following the wholly inappropriate and flawed use of coded data by the CQC as part of its “intelligent monitoring” risk assessment, practices are understandably anxious about how data that is extracted will be used.’

Dr Robert Morley, head of the GPC’s contracts and regulations subcommittee, said: ‘The document is from HSCIC and GPES but forwarded via area teams by NHS England. It directly contradicts the contract changes agreement and GPC is taking the matter up urgently with NHS England.

‘My hunch is that this probably represents cock-up rather than conspiracy but nevertheless suggests a deeply worrying lack if understanding by those who should know better of GP contractual obligations, clinical autonomy, the difference between essential services and QOF and the nature of the agreement that was reached.’

He added that there were implications around ‘how practice performance might be judged in future, for example by CQC. and the ‘increasing likelihood of local deals replacing QOF’.

He added: ‘We’ve already seen one disastrous example of this, of course, with the CQC “intelligent” monitoring debacle for those practices that had opted into a local QOF all being given a “high risk” ranking.’

HSCIC was approached for an explanation but said this was a matter for NHS England.

Pulse is still waiting for a clarification from NHS England.

The GPC negotiated wide-ranging changes to the QOF ahead of the 2014/15 contract, including the retirement of 24 indicators worth a total of 185 points from the clinical domain and 14 indicators worth 33 points from the public health domain.