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QOF threshold hikes delayed for a year

Planned hikes to QOF attainment thresholds have been delayed for a year under a radical reshaping of the framework in the new GP contract.

The Government said in last year’s contract deal that it wanted the upper thresholds for all QOF indicators in England to rise in line with the upper quartile of GP performance.

The upper thresholds for 20 indicators rose to this level last year, but the planned hike for the other QOF indicators will be delayed until 2015.

The GPC has managed to remove many of the QOF indicators introduced in the contract imposition last year, with QOF reduced by 40% and most of the funding ploughed back into the core contract.

A large chunk of indicators – worth 341 points – will be completely retired, including:

  • In hypertension, the unpopular GPPAQ screening indicators have been ditched, along with the tighter 140/90 mmHg blood pressure target.
  • Lifestyle checks of people with hypertension, as well as the smoking register have also been taken out. And the newly introduced bio-psychosocial screen for people with depression is gone and not replaced.
  • A total of five diabetes indicators are out, with measures on renal function, eye screens, dietary reviews and erectile dysfunction all retired, as are cholesterol checks for patients with CHD, peripheral arterial disease or stroke/TIA - and cholesterol, glucose and blood pressure checks in patients with schizophrenia.
  • Also gone are hypothyroidism register and monitoring indicators, TSH monitoring in people with learning disabilities and maternity service, child health surveillance, epilepsy and rheumatoid arthritis indicators.

Many of the changes reflect suggestions made by a commission from NICE on how to pare down the QOF. Bolder steps include the removal of a LARC indicator in contraception and the indicator for cervical screening results system, areas NICE had proposed reforming, but only with discussion of the impact with Public Health England.

Dr Richard Vautrey, deputy chair of the GPC, said many Government-imposed indicators were to be removed or reduced.  

He told Pulse: ‘What will be removed is virtually all the imposed indicators – things like the GPPAQ surveys, the points linked to erectile dysfunction in diabetes. The patient experience points are a large chunk, together with child health surveillance, maternity payments.’

‘There are big changes to cholesterol monitoring across QOF, like the requirement to do annual blood tests for patients with CHD and other conditions. Clinicians will be expected to do them when clinically appropriate, but not forced to do them as part of the QOF requirement.’

The hypertension domain is to be ‘significantly reduced down’, while many decisions made for this year’s contract have been reversed.

He added: ‘One of the big changes that happened with the imposition was the blood pressure indicator related to the annual checks of people with hypertension was reduced from 150 over 90 to 140 over 90. That has been reversed as part of these changes.’

‘As part of the agreement, the thresholds remain the same. They have not imposed the threatened change to thresholds that would have been imposed as part of the second year of the imposition.’