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Smaller QOF being considered under radical rethink of GP contract by NHS England

Exclusive NHS England are considering radical proposals to scale back the size of the QOF to free up resources for more ‘creative’ ways of incentivising GPs to improve patient care, says the new head of primary care commissioning.

In an exclusive interview with Pulse, Dr David Geddes said that the proportion of funding tied to QOF was currently ‘quite large’ at around 17% and that he was considering working with NICE to reduce it.

The move comes as NHS England prepares for a major shake-up of practice funding with a new primary care strategy to be published this autumn.

Dr Geddes, who is also a part-time GP in York, said that NHS England was currently consulting with CCGs, the RCGP and the GPC and that he expected the strategy to include ‘more creative’ ways of incentivising GPs to work towards ‘outcomes rather than processes’.

He also said that the body also would like to move away from annual reviews of the GP contract, in favour of developing a ‘flexible contract’ that could be better applied more locally.

He said that GPs required more ‘head room’ to provide preventative care, and that they were going to ask NICE to rationalise QOF to remove indicators that are not evidence-based or link with outcomes.

Dr Geddes said: ‘I think we have to recognise that QOF has played a part in achieving quite a lot over the years but it may not necessarily be the vehicle by which we continue to invest or to change clinical priorities.

‘It is really an opportunity for us to work with NICE to be able to decide which of the QOF indicators are most useful and most evidence based and most likely to be able to produce that change.

‘QOF counts for around 17% of practice income which is of course a large amount and it may well be that we wish to look at having a different mechanism for commission for some of those enhanced areas of care without it having to be through the QOF process.’

He added that NHS England recognised that GPs needed the freedom to develop a more preventative health service by removing some of the more ‘tick-box’ elements of the contract.

He said: ‘We need to be creating some head room and space for other doctors who are busy and who need to be supported in being able to provide a different sort of service.’

Dr Geddes added that the strategy could also remove the need for annual contract negotiations: ‘There are areas of the contract that will no doubt have to be discussed, but we want to be able to agree a plan, going forward, and then see how that will evolve over a period of time.

‘We need to be able to find a flexible kind of contract which gives us that approach forwards, so we have that agreement where we are headed. It will be part of a broad dialogue for the vision of what primary care will deliver in the future.’

As part of that vision, Dr Geddes also said that they were looking at changes to the GP contract to enable local area teams and CCGs to jointly commission services with one standard contract across primary care, secondary care and community services if it was needed to join up care.

GPC deputy chair Dr Richard Vautrey warned that GPs were weary of constant change to their contract, but that they would consider any proposals.

He said: ‘This appears to be a major change to the GP contract at a time when practices are worn down by constant change that simply adds more work and takes away funding.

‘I am sure that NHS England is hearing this message loud and clear from their discussions with other bodies and it is something that cannot be ignored.

‘We will discuss any proposed changes with NHS England as part of our regular negotiations but they should be under no illusions as to the severe and unsustainable workload pressures practices are currently experiencing and any future contract changes must primarily address this.’

Professor Clare Gerada, RCGP chair, said any move to reduce GPs’ QOF workload would be ‘wonderful’.

She said: ‘What I think they are talking about is targeted care where those who need it most are given longer consultations to help improve continuity and decrease fragmentation. That would be good.

‘What the college is saying is we need more GPs spending longer with their patients, with longer training. Anything that frees up GPs to spend longer with their patients, and help to improve continuity, will reduce hospitalisation, which is what we need.’