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Practices face ‘pedantic’ claims over QOF points

Exclusive: LMCs are warning practices are facing unprecedented scrutiny on their achievement under QOF and enhanced services, as ‘officious’ managers battle to balance the books.

GPC leaders have met the NHS Commissioning Board to raise concern over primary care organisations’ increasingly inflexible approaches to handling payments, amid concerns that the loss of PCT staff has exacerbated the problem in England.

LMCs across the country told Pulse that processes had become noticeably more arduous, with payments for quality and productivity (QP) indicators and the patient participation DES among those causing difficulty. 

Cambridgeshire LMC said seven practices had appealed against NHS Peterborough’s decision not to award points for QP indicators this year, with three appeals rejected, three awarded some of the points, and just one decision fully upheld.  

South Staffordshire LMC said it had also had ‘issues’ with QP indicators. 

Dr John Allingham, medical director of Kent LMC, said the process of QOF appeals in the county was ‘stricter and more pedantic than ever before’. 

Writing in the LMC newsletter, he advised members: ‘If there is a hoop it is better to jump through it rather than try and argue that in going around it the same objective was achieved.’

Dr Tony Grewal, medical director of Londonwide LMCs, said: ‘This mirrors our experience of onerous and pedantic assessments of claims for QOF points carried out by PCTs and their successors. This has completely overturned the spirit of the new GMS contract of “high trust, low bureaucracy”.’

Dr Richard Vautrey, GPC deputy chair and a GP in Leeds, said the issue was being exacerbated by support staff being more remote, which had caused a more ‘officious’ approach. 

He said: ‘There are fewer staff with experience of local practices, so PCTs are resorting much more to sticking to the letter of the law.  It’s one of the things we’ve talked to the national commissioning board about. The way local area teams operate is very much on our agenda.’

A Pulse survey published last month found one in eight practices was owed DES funding, with nine taking legal action to recapture the money.


Analysis: Managers turning the screw


Where practices are facing scrutiny

  • QP indicators: Indicators requiring practices to formulate plans to reduce prescribing costs, referrals and emergency admissions have proved troublesome
  • Patient participation DES: Introduced in 2011, the DES requires practices to demonstrate patient engagement