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Q&A: Why have GPs been allowed to ditch the QOF?



What have GPs been allowed to do in Somerset?

According to NHS Somerset CCG, GPs have been given the go-ahead to stop reporting their QOF achievement, initially for the remaining three months of the financial year, in order to give them ‘head-space’ to think about alternative ways to improve primary care in the area.

 

What will they have to do instead?

Each practice will have to ‘actively participate’ in drawing up a plan for redesigning GP services locally (i.e. attend a minimum of three discussions), which will include initiatives on long-term conditions, access to primary care, reducing ‘unwarranted variation’ and enabling more services to be moved into the community and primary care. They must then submit a written response giving their views on the draft proposal.

 

Will they still be paid for QOF?

Yes. Each practice will receive QOF payments for January to March 2014 based on their QOF payments for 2012/2013. Practices may request payment for actual QOF performance in 2013/2014 if this is likely to be ‘significantly’ improved on the previous year. But the costs of participating in the redesign process are to be borne by the GP practices. NHS Somerset CCG said that ‘good quality care’ would meant that GPs would continue with many of the clinical activities mandated by the QOF, but in a more patient-focussed way.

 

What happens after April?

If the area team, the CCG and LMC and practices all agree the proposals are workable, practices will begin implementing them from April, with ongoing testing and evaluation to be carried out throughout the year. NHS Somerset CCG says that QOF payments will continue, but participating practices can request reimbursement for QOF work based on their 2012/13 acheivement.

 

Do all GPs have to take part in the scheme?

Practices were given the option of joining in the scheme or continuing with QOF as normal. Out of 75 practices in Somerset, 70 had signed up as of Monday. Once the initial three month ‘planning’ phase is over, even if the CCG, area team and LMC wanted the scheme to go ahead, it would need to have a ‘significant’ number of practices are on board to continue.

 

What if GPs change their mind?

Individually, practices can pull out if they wish to – and the CCG says there will be an exit strategy built in for reverting all member practices to the national QOF arrangements if necessary.

 

Are other areas of the country also dropping QOF work?

So far practices in Devon, Cornwall, Lincolnshire, Leicester, Leicestershire and Rutland have already stopped reporting indicators that will be dropped from the national contract from April, in return for starting work early on the new enhanced service on unplanned admissions. The scheme will see them paid for the remainder of the year based on QOF achievement for 2012/2013. Other CCGs have asked their local area team for the same treatment, but have been told ‘no way’.

 

What does the GPC think?

The GPC is unhappy with the Somerset arrangement, feeling it undermines the national contract – and could backfire on participating practices without properly negotiated terms. Dr Richard Vautrey said: ‘There’s a real risk that practices find themselves in the same situation that PMS practices now find themselves, where initially it sounds like a good deal to have more of a local contract with favourable conditions but it’s much more difficult then to get back to national arrangements if they find they are no longer getting favourable agreements and things have deteriorated.’But the GPC thinks bringing the 2014/2015 QOF agreement forward ‘makes sense’ so practices do not have to chase soon-to-be redundant points and can instead get on with productive work.

 

How could it affect national negotiations?

Not clear – the GPC has cautioned it could ultimately undermine national bargaining if more areas follow suit. On the other hand the QOF is optional and the CCGs involved have stressed they are in support of a continued national agreement.

 

Does this mean that I don’t have to carry on with QOF?

No. Some CCGs and area teams may be open to coming up with similar schemes – but time is running out to implement them before the new contract comes in.

 

What does NHS England say about this?

NHS England has backed its local area teams in allowing some GP practices to ditch the QOF for the rest of this financial year, saying that it was an example of an ‘innovative solution to commissioning primary care’.