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LMCs urge GPC to reverse policy to scrap QOF amid new workload fears



GP leaders have been instructed by the LMCs Conference to negotiate to retain the QOF in England, marking a U-turn from the GPC’s current policy.

The BMA’s Urgent Prescription for General Practice, published last year, called for the end of the QOF while returning all related investment into core GMS/PMS funding.

But on Friday, LMC delegates voted in favour of a motion that said ‘disinvestment from QOF is no longer desirable’ and called for the GPC to agree a revised framework with indicators that are ‘evidence based’ and ‘clinically relevant’.

The motion in full

Agenda committee: That conference believes:

(i) That disinvestment from QOF is no longer desirable as QOF has shown quality improvements and provides good data;

(ii) That evidence-based chronic disease management is an important form of general practice funding and needs to be maintained;

(iii) That GPC England should develop and agree with government a revised QOF which should be evidence based and clinically relevant;

(iv) That indicators should have clinically appropriate timeframes for data collection;

(v) That successful indicators should not be retired, and that new indicators should attract new funding when they are introduced.

Proposing the motion, Lincolnshire LMC medical director Dr Kieran Sharrock said this comes as GPs were increasingly concerned that ‘if we got rid of QOF the money would get moved into something else – seven-day working QOF, or “my favourite disease” QOF’.

He also demanded an end to the retirement of QOF indicators, because ‘when you retire QOF points, they don’t get retired – we know people still keep looking at what we’re doing for depression and diabetes and all these things that have disappeared’.

Instead Dr Sharrock said GPs wanted GPC to negotiate an alternative QOF with simplified indicators, and more realistic timeframes.

He said: ‘What we want is no old work without the old money. So don’t retire anything from QOF but when things get added, new money comes with it.’

Speaking in support, Dr Girish Chawla from Cleveland LMC said ‘losing the QOF funding will further destabilise primary care in times of uncertainty’ and that ‘there is scope to simplify the QOF templates as suggested because some do involve a lot of tick boxes’.

He added: ‘We have good evidence it has improved quality, especially for chronic disease management and most importantly it is also reducing health inequalities and the postcode lottery.’

Dr Andrew Green, the GPC’s policy lead on the QOF, said: ‘From talking to GPs it does seem like QOF is rather like that elderly and demanding relative who has driven you to distraction for the last 15 years and then you realise after all she might be dying now, and you might actually miss her once she’s gone.

‘There might even have been some hidden advantages to looking after her like having the house to yourself for a couple of days every couple of weeks while your wife goes over to visit her.’

The QOF hokey cokey

NHS England has said it is ‘committed in principle’ to scrapping the QOF after its chief executive Simon Stevens stated that the QOF had ‘reached the end of its useful life’ and would be phased out of the GP contract by 2018.

At the time, the GPC said it supported the move which was in line with its calls for reduced ‘box-ticking and bureaucracy’.

But, despite last year’s GP contract agreement explicitly stating that negotiations for 2017/18 would explore the option to completely abolishing the QOF no such changes were agreed for this year.

And Pulse recently revealed that the GPC in England has met with NHS chiefs to discuss the introduction of more flexible indicators on diabetes for next year’s contract, casting doubts on whether the framework would be dropped after all.

It comes as Scotland has already dropped the QOF from the GP contract altogether, while GPC Wales and Northern Ireland both negotiated suspensions of the QOF earlier this year to help ease pressure on GPs.