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High-achieving practices get extra leg room on QOF productivity indicators

By Lilian Anekwe

GPs have been offered significant concessions in their bid to meet new QOF quality and productivity indicators, with new guidance allowing them to side-step several key elements and still earn points.

Joint guidance from the GPC and NHS Employers, published last week, allows GPs to earn controversial QOF points in prescribing, referrals and outpatient admissions without meeting every requirement, and extends the timescale in some circumstances.

The guidance follows uproar from GPs after publication of the indicators, with three-quarters saying they were not achievable, and a Department of Health official pledging to look again at some details.

Practices will be allowed to simply maintain prescribing performance when agreeing three areas for focus with their primary care organisation rather than demonstrate improvement, if they are already 'achieving a high standard of cost-effective prescribing', and have no further improvements to make. Click here to read the full guidance

'In circumstances where practices are considered to already be achieving a high standard of performance in all areas of prescribing, where there is very limited scope to improve, then if agreed with the PCO, the focus of practice reviews and subsequent improvement plans can be on the practice maintaining performance,' the guidance says.

The same applies to indicators on referrals and emergency admissions, which reward practices for meeting internally to review data, and propose areas for service and commissioning redesign and three new care pathways.

The guidance says: 'In the event there are no areas for improvement, the practice should state this in its report. Evidence should be provided that the practice has adequately carried out the external peer review.'

Practices will have deadlines for submitting reports moved back if PCOs fail to get data to them 'within a reasonable timeframe'.

And as Pulse revealed in April, GPs in PCOs employing referral gateways have been offered a workaround so they can earn points without hitting requirements to the letter after an official admitted the targets were unworkable in some areas.

GPs unable to bring about any change to care pathways because their referrals are screened by external agencies can still claim points as long as they document the situation: 'During external peer review, practices should identify any areas for commissioning or service design improvements which are then raised with the PCO. This could include suggestions about how a referral management centre is used and if there are any processes that could be improved.'

The guidance makes clear any new work expected of GPs and practices should be incentivised with additional, new money: 'If the PCO decides to commission a new pathway that improves quality or productivity but involves additional workload… it should resource it separately as a commissioning exercise.'

Click here to read the full guidance

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