Northern Ireland’s Department of Health has suspended QOF for this year to reduce ‘administrative burden on practices’ following contract negotiations with the BMA.
The two parties also agreed to begin gathering more detailed general practice activity data, in order to ‘create a narrative’ showing ‘just how stressed and stretched’ the service is, according to BMA NI GP Committee chair Dr Alan Stout.
Negotiations on the GP contract for 2023/24 closed at the end of March and Dr Stout said the GPC had achieved their ‘top ask’ in securing a suspension of QOF reporting.
The Northern Ireland health department previously suspended QOF for two years during the pandemic until April 2022, and then offered an optional suspension in late 2022, which was conditioned on practices providing an enhanced service for nursing homes.
Dr Stout told Pulse the suspension for this year has ‘no strings attached’, but said the GPC is aware this is ‘not a magic bullet’ and will not solve all the problems in general practice.
Reaching agreement was ‘relatively straightforward’, in part because Northern Ireland does not currently have a government in place, and ‘partly because the situation is just so dire here’, according to Dr Stout.
He said: ‘We’re aware that the Department have moved further than they are comfortable with potentially, with no minister place, up to agreeing whatever mitigations we can just to try and sustain the service.’
The Department’s director of primary care Gearóid Cassidy wrote to Dr Stout on 28 March to set out the agreed contract changes.
Mr Cassidy wrote: ‘It is recognised that General Practice is under pressure, with practices facing high levels of demand.
‘The Department has been exploring how to support practices through difficult times, while maintaining assurance over the quality of care delivered to patients, particularly those with chronic conditions.
‘On that basis, the Department has agreed that QOF will be suspended for payment purposes for the 2023/24 year, with no financial detriment to practices, as a means of stabilising GMS services by reducing administrative burden on practices.
‘Enhanced Services are not being downturned and will be commissioned in line with normal arrangements.’
GP practices will therefore no longer have to record QOF activity, however they will still be required to deliver care to these patients.
QOF outcomes will be monitored by the health department’s Strategic Planning and Performance Group (SPPG), which is responsible for delivery of health services in Northern Ireland, and any negative impact on patients will be escalated for discussion with the GPC.
Chair of the RCGP NI Dr Ursula Mason welcomed this freeze on QOF, ‘in recognition of the huge pressures GPs across Northern Ireland are facing as we seek to manage growing demand’.
On the new data reporting agreement, Dr Mason said: ‘It is essential that we are accurately gathering data on GP workload and consultation numbers, but this must be done in a way that does not add more work to GPs already stretched far beyond capacity.’
The contract letter said GP practices will this year be required to ‘standardise how GMS activity is captured and coded’ and ‘agree that this data will be extracted to create a new GMS activity dashboard’.
Speaking to Pulse, Dr Stout emphasised that the creation of the dashboard will be automatic and will not require manual entry from GPs.
He said this exercise is advantageous to both GPs and the Department because it will ‘start to create a narrative around just how much activity is going on in primary care’ and this will inform both workforce planning and funding in the future.
However, he added: ‘The biggest challenge is going to be actually having the activity on the computer system. General practice is full of notes and post-its about ringing people back, so to be counted it needs to be on the system.’
The RCGP’s Dr Mason also said that while these contract changes ‘provide some relief in the short term, solving the crisis in general practice requires a long-term solution and sustained investment’.
And last month, Dr Mason warned that around 30 practices were at risk of closure and receiving recovery support, which is almost 10% of the total 318 in the country.
Dr Stout said that during this year’s contract negotiations, there was a recognition from the GPC that the Department was struggling with the current political situation.
He said: ‘Civil servants are being put in an impossible position with no ministers, no political scrutiny, no health committee. There really is a shared feeling of just how difficult public service is.’
As part of a recent series on the state of general practice in the devolved nations, Pulse examined how the political situation in Northern Ireland was hampering progress towards stabilising the service.
The country has been without a first or deputy first minister for over a year, the Executive Committee has not met and civil servants cannot make any ‘political’ decisions, only follow policies previously set by ministers.
However, the Department of Health officials still had the ability to negotiate with the GPC on contractual arrangements without ministerial direction.