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QOF audits to form part of ‘value for money’ drive in NHS



Exclusive Practice QOF points are to be the focus of a new cost-saving drive in the NHS after local area teams were instructed to stamp out fraud and ensure ‘value for money’.

Pulse has learnt that NHS England has changed the remit of the annual QOF audits that used to be carried out by PCTs to verify the performance of practices under the framework, and has linked them with the QIPP drive for greater efficiency in the NHS.

The body said that QOF audits will now have a new focus on ‘quality improvement’ and that the body had added the responsibility to ensure ‘contract compliance, value for money and eliminating fraud’.

The move comes despite a major report in 2011 exonerating GPs of ‘gaming’ the QOF, and after GPC concern that the changes to the framework this year would force an increase in exception reporting rates.

GP leaders have criticised the move, with one LMC saying that their LAT has already trebled the number of practices it intends to audit as part of its QIPP plan to maximise savings.

A spokesperson from NHS England told Pulse that they had changed the requirements on LATs to check QOF performance at GP practices.

He said: ‘Before April, primary care trusts were expected to conduct QOF visits to verify the income providers were claiming. The new focus is one of quality improvement – a responsibility shared between NHS England and the CCGs.

‘NHS England has an added responsibility to ensure contract compliance, value for money and eliminating fraud. This shift in emphasis from QOF verification to quality assurance is NHS England policy.’

He added that area teams were encouraged to conduct ‘random quality assurance visits’ and use GP practice performance information as a guide for when to make any follow up enquiries as part of their quality assurance responsibilities.

The development comes as it emerged that the Essex local area team will audit the QOF scores of three times as many practices this year, in a development that has concerned LMC leaders.

In a letter to local GPs seen by Pulse, Essex LMC chair Dr Brian Balmer said this ‘completely changes the context’ of the visits, with the audits no longer a ‘legitimate exercise’ but one to ‘prevent payments’ to GPs.

He added that last year only one out of 15 practices escaped the process without money being clawed back by the PCT.

The letter said: ‘The LMC has always supported reasonable actions by the NHS to audit payments to practices as part of its duty to safeguard public funds from potential fraud. As part of this co-operation, I have regularly drawn practices at random for QOF post-payment verification visits.

‘Guidance on a sensible number of practices is commonly accepted as being around 5%, but this year the Essex area team has decided unilaterally to arrange visits to 42 practices, which is 15% of the total. They have also said that this is not to audit against potential fraud, but that this is part of their QIPP (or money saving) plan.’

GPC chair Dr Chaand Nagpaul said he was not aware of other LATs increasing the number of QOF audits, but said they should not be lined with saving money. He said: ‘It is hard to understand how you can link QOF with QIPP. There is no clear link between the two.’