Almost half of GPs would back a switch from the nationally negotiated QOF deal to a local contract if offered by their CCG, with several saying it would be more relevant to local health needs and allow them to spend more time with patients, according to a Pulse survey.
Around 46% of 413 GPs, surveyed this month, said that ‘in principle’ they would follow Somerset’s lead and opt out of QOF locally if their CCG offered an alternative as the scheme was ‘no longer about patient care’ and a new focus on local budgets meant it was ‘ludicrous’ to have national targets.
Just 17% of GPs said they wouldn’t consider leaving the national scheme, and 37% of GPs were wary of the details, saying they were undecided which way to go until they saw local proposals.
The GPC agreed that there is value to local programmes ‘on top of a national scheme’ and has said the results indicate GPs are ‘rightly’ undecided on a wholesale shift from the contract.
In Somerset, GPs have been told they can ditch the QOF this year, while the LMC, CCG and local area team negotiate a new scheme that reflects local priorities. NHS England approved the locally negotiated deal, but said that further deals will not be approved this year.
However the GPC has hit out against such deals, saying they undermine the national contract and, at the annual LMCs Conference in May, GP leaders voted against propagating further local devolution.
Dr Simon Ruffle, a GP in Twyford, Berkshire who voted in favour of opting out of the national QOF scheme, told Pulse that a local scheme would allow practices to focus on improving weaknesses rather than meeting ‘ludicrous’ central targets.
He told Pulse: ‘Now that budgets for primary care services are expected to be spent wisely and locally by CCGs and increasingly the local authorities with integration with social care it seems ludicrous to have a central QOF targets.’
‘Locally, our diabetes care could be better. We know this takes a lot of resources for practice nurses and doctors to be trained to deliver the services. Our cardiovascular care is very good and we are not likely to let those gains slip.’
‘If we can invest more into primary diabetes care we could improve things further. This would take a local agreement rather than national.’
Dr Ruffle added that funding must be maintained for practices to improve on underperforming areas, but said they could not be expected to maintain the administration of the rest of QOF as well.
Dr Peter Swinyard, chair of the Family Doctors Association and a GP in Swindon also said that he would ‘in principle’ back a local contract and opt out of QOF, but ‘it would have to be an innovative scheme’ to convince him.
He said: ‘I’m quite happy for people to have local quality schemes, which – having looked at public health, [and consulted widely] – say “ look we want to incentivise practices to do this, and put some money out there so people can do it if they wish to.”’
But he added there was a risk with losing the national QOF that many of GPs ‘will continue doing that work regardless, because we believe it’s good clinical work. If you remove the remuneration for it, and put it into a local project, it doesn’t mean you remove the work as well.
‘And there’s a serious risk of asking us to do yet another thing to earn back the money which has been taken away from us.’
He added: ‘There is an enormous danger of being divided and ruled, in all sorts of ways, in respect of our GP contracts. And NHS England is all too keen to put a crowbar in between groups of doctors and lever.’
GPC Chair Dr Chaand Nagpaul echoed these concerns, and said that Pulse’s results accurately reflected the cautious mode amongst GPs.
Dr Nagpaul told Pulse: ‘I think that reflects that, rightly so, GPs should be undecided because we don’t know the consequences of this.’
‘We need to be very careful, the last thing we need is an unintended consequence, of GPs doing the same work, for less resources, and then having to work hard to earn that resource back.
He added: ‘It’s the nature of local negotiations that GPs would work to different arrangements, of varying levels of workload. That is always a risk of the negotiations, and I think we need to be very careful in how we look at them.’
‘Clearly there is value in elements of local schemes, in every area, resourced by CCGs or the area team, on top of a national contract.’
An NHS England spokesperson told Pulse: ‘We will be carefully monitoring and evaluating the Somerset quality scheme pilot to understand the impact it has on quality of care and health outcomes to help inform our thinking going forward.’
Question: Do you think that the 2004 GP contract should be renegotiated?
Yes – 188 (46%)
No – 71 (17%)
Don’t know – 154 (37%)
About the survey: Pulse launched this survey of readers on 30 June 2014, collating responses using the SurveyMonkey tool. The 29 questions asked covered a wide range of GP topics, to avoid selection bias on any one issue. The survey was advertised to readers via our website and email newsletters, with a prize draw for a Samsung HD TV as an incentive to complete the survey. As part of the survey, respondents were asked to specify their job title. A small number of non-GPs were screened out to analyse the results for this question. This question was answered by 413 GPs.