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NHS should use ‘reputational threats’ to keep GPs in line, says expert

Payments to practices under the QOF are unaffordable and should be torn up and replaced with a system to create ‘threats' to GP's reputations if they do not comply, claims a top health economist.

The claims come in a perspective piece on how the NHS Commissioning Board will deliver the £20bn savings needed in the NHS over the next four years.

Professor Alan Maynard, professor of health economics at the University of York and a member of the board of the Vale of York CCG, warned GPs to prepare for ‘radical' change  over the way their performance was managed by the board.

Writing for the Journal of the Royal Society of Medicine today, Professor Maynard said the NHS Commissioning Board would have to focus on redrawing the incentives for GPs, including QOF.

He wrote: ‘It is time to reform primary care with the vigour and persistence shown in reforming secondary care in recent decades.

‘Radical attempts to reform the provision of primary care should be expected as the commissioning board pursues improved productivity throughout the NHS in order to achieve the saving and recycling of £20bn over four years.

‘Interventions to reduce practice variations are unlikely to use financial incentives using bonuses primarily due to funding constraints.

‘Instead there will be more focus on policies which create threats to income and reputational incentives i.e. identifying outliers in activity and outcomes, and relying on peer pressure and professional pride to motivate change.'

Speaking to Pulse, Professor Maynard explained that he thought the £1.2bn spent on QOF was a waste of money and should be deployed elsewhere in the NHS.

He said: ‘The QOF is paying people for things they should be doing already. It needs radical reform.'

He added that GPs were naturally competitive and incentives needed to tap into their professionalism and reputation among their peers.

He said: ‘It raises a whole issue about how we provide primary care because QOF is largely provided by nurses anyway.'

Data comparing activity of practices, PROMs measures and if necessary putting failing practices out to competitive tender should all be used to improve primary care provision, he added.