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Practices forfeit QOF income over A&E plans

Exclusive: Practices are struggling with the new A&E indicators in the QOF, with almost a third missing the initial deadline to review casualty visits by their patients.

With £900 of lost income at stake for the average practice, some primary care organisations have been forced to issue a blanket extension to the deadline for practices to report on how their access arrangements might be a factor in avoidable A&E visits.

But other PCOs said they would hold fast to the 31 July cut-off for indicator QP12, and practices that had failed to meet it would miss out on the QOF cash.

LMC leaders are blaming the problem on workload, flaws with the indicator and the failure of some PCOs to provide practices with A&E attendance data, leaving GPs unable to conduct a practice review. They warned practices now face an uphill struggle to hit indicators QP13 and 14, together worth £3,210 to the average practice. These require practices to take part in external peer review of their A&E data and agree an action plan by the end of this month – then put that plan into practice by 31 March.

Data from 28 PCOs collected by Pulse showed 29% of 2,331 practices failed to meet the 31 July deadline to produce their QP12 report, although the majority have now been granted an extension by their PCO.

Among the areas to grant extensions to all practices were NHS Walsall, NHS North West London and NHS Hertfordshire. However, NHS Birmingham cluster said the 15 practices that missed the July deadline ‘will not qualify for the points associated with QP12′. NHS Bournemouth and Poole, where 20% of practices missed the deadline, said while some were permitted extensions ‘a couple’ were not and ‘therefore will not be paid’.

Dr Nigel Watson, chief executive of Wessex LMCs, said there was ‘a problem with practices getting the information, and once they looked at the data they struggled to see any patterns or draw any conclusions’. He added many GPs felt A&E attendance was beyond their control.

Dr Robert Morley, executive secretary of Birmingham LMC, said single-handed practices had struggled: ‘Some practices might have decided it was not worth it, and they’ll forfeit the funding.’

The Department of Health introduced the three new A&E indicators on a 12-month trial basis in April, to replace the scrapped QP prescribing indicators. For QP12, practices are required to focus their efforts on A&E attendances by high-risk older patients, children under 16 and frequent attenders. Their report must identify patterns and consider whether improved same-day access at the practice could reduce A&E visits.

NHS Employers said that as the three indicators followed on from each other, missing QP12 ‘could result in an inability to achieve QP13 and 14′.