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One in four practices would lose £5,000 under plan to raise QOF thresholds

Exclusive: A quarter of GP practices will lose around £5,000 in QOF payments if the Government accepts NICE recommendations for achievement thresholds to be raised across the board, research shows.

Figures seen by Pulse reveal that if indicators are raised by 5% across the QOF, as proposed by NICE, a quarter of practices would miss out on payment in at least five indicators.

One in ten would miss out on ten indicators, worth around £10,000, and one in twenty would fail to achieve 15 or more indicators – at a cost of £15,000 or more.

In certain indicators, such as CHD8 - the percentage of patients with coronary heart disease whose total cholesterol in the preceding 15 month is 5mmol/l or less – the number of practices more than 5% below the threshold would increase five-fold, and the number more than 10% below the threshold would more than double.

Pulse revealed last month that NICE experts had begun moves to reshape the QOF and increase GP performance by significantly toughening up both minimum and maximum payment thresholds.

Speaking to Pulse, Dr Tim Doran, clinical research fellow at the University of Manchester whose research formed the case for raising thresholds, said it was the best way to continue to incentivise improved GP achievement.

‘Existing thresholds are not doing the job any more. All we're trying to do is set thresholds in an appropriate level, by using performance by practices over seven years of the QOF to set new benchmarks, rather than guessing. We can look at where the top 25% of practices are we can use that as the benchmark for the maximum.'

The QOF indicator advisory committee agreed to propose a trial of raised thresholds to GPC negotiators, to investigate the effect on achievement and on unintended consequences – which Dr Doran proposed would be a national trial in GP practices.

Committee members and GPC negotiators both raised concerns that changing thresholds would have unintended consequences – disincentivising practices, encouraging exception reporting, and creating narrow payment thresholds that would penalise small practices.

Dr Doran said: ‘We have modelled what would happen if we set thresholds in the new way and overall small practices do not lose out.'

‘But almost inevitably you will have to improve to earn the money. In all likelihood most practices will see a decrease in income and you will not see the same payment as last year.'