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Proposals to merge QOF with hospital incentives system being considered by NHS managers

NHS England is considering recommendations to merge QOF with enhanced services and the incentive system for rewarding trusts, following a report by an influential think-tank.

The Nuffield Trust said the controversial move to combine GP, hospital and community incentive strategies could increase integration across health services, ensuring better coordination of care and more efficient patient handovers.

It comes as NHS England and Monitor are currently reviewing payment models in the wider NHS, and NHS England indicated that it will be taking this report ‘into account’ when deciding on further changes to the QOF.

GP leaders said that the Nuffield Trust’s recommendation would be a retrograde step, as it would be making a return to using QOF for management purposes.

In a report published this week, the Nuffield Trust wrote: ‘We suggest that Monitor and NHS England should explore whether at least part of the existing pay-for-performance schemes (QOF and CQUIN) and local enhanced service contracts could be combined and reformed to incentivise coordination of care across hospital, mental health, community and GP services, and more appropriate and efficient transitions of care between settings. ‘

‘In some ways, the requirement for GPs to be accountable leads for the care of older people is a step towards this, but it could go furtherby aligning the GP reforms with the CQUIN payments to other NHS providers delivering care to the elderly and other patients with complex needs,’ it added.

It comes as NHS England’s ‘Call to Action’ for general practice is currently reviewing a number of issues that the Nuffield Trust has analysed in previous reports, including the need for GP contracting to allow for practices to deliver care ‘at scale’ as well as the need for GPs to work together in federations.

An NHS England spokesperson said: ‘NHS England will be conducting a review of incentives for 2015/16 and beyond. This review will consider wider primary care incentives. As part of this review several options will be explored including innovative flexibilities around existing and new incentive models.’

‘NHS England will take this and other reports and views into account. This review is still at the planning stage.’

But GPC deputy chair Dr Richard Vautrey warned against making a return to using QOF for management purposes.

He said: ‘I think practices would be concerned if QOF were to be used in that way. I think the changes that we made this year have focused QOF far more onto the clinical priorities, the relevant issues, and moved away from a focus on systems and management – such as the QP QOF domain which is causing lots of problems around the country.’

However, Dr Vautrey added that some alignment of incentives would be helpful to avoid problems with patient transfers in the current system.

He said: ‘What would make some sense is if we were to outline the key priorities across the NHS, and ensure that everyone was working to the same targets.’

‘For instance, that there was the same levels of diabetic control in hospital as is incentivised in general practice. It irritates practices no end when their patient is seen in the diabetic clinic and then the letter returns to the practice without the key information that they need to support their incentives within QOF.’

‘If we were to ensure that for example immunsations, or particular key clinical areas, were incentivised in the same way then at least we would all be singing from the same hymn sheet.’

NHS England refused to give details on what they may look at as part of the review of primary care incentives, with the spokesperson saying: ‘It’s too early to talk about specifics.’

It comes as the GPC and NHS England negotiated a contract settlement for 2014/15 that will strip out 40% of the QOF in return for GPs taking on the Government’s flagship ‘named GP’ role.

NHS bosses are also reviewing what new ‘contractual elements’ are needed to enable CCGs to jointly commission primary care with area teams, it emerged earlier this month.