By Alisdair Stirling
Exclusive: GP consortia are to be controversially handed responsibility for performance management of practice contracts, with a specific role in policing QOF achievement and cracking down on exception reporting.
The Department of Health revealed to Pulse that consortia would be required to monitor practices on the QOF and other areas of the GP contract, and to report all under-performers to the NHS Commissioning Board.
The new role threatens to create major tensions between practices and consortia, who will be expected to show their scrutiny is tough enough as part of a legal duty to work with the board to improve standards.
It comes after a report by the Audit Commission warned PCTs had been ‘lacking' in their approach to auditing GP performance on the QOF, and claimed some trusts could not be confident payments to GPs were legitimate.
A DH spokesperson said: ‘The Health and Social Care Bill will give GP consortia a legal duty to support the NHS Commissioning Board in continuously improving quality of care. This could include supporting practices to meet the quality improvement outcomes in the QOF and reviewing practice performance. If any contractual issues arose they would then need to report them to the board.'
Dr Richard Vautrey, GPC deputy chair, said the handover of control of QOF management was ‘under discussion' with the DH, along with future funding of the scheme. He confirmed responsibility for the QOF would pass to consortia, and said they might have to set up ‘performance management units', to oversee QOF management and avoid conflicts of interest.
‘If a consortium was big enough it would have its own performance management unit – like in a PCT – that would take on management of GP contracts within the area,' he said.
For consortia to set up such units would be hugely controversial, since it would leave them only a small step away from formally holding practice contracts.
Dr Vautrey said the GPC would oppose any move to bring in local elements to the QOF as a further stage in contractual management: ‘We want to retain a national system for the benefit of all patients wherever they live. With the scrapping of practice boundaries, and patients moving where they like, it would be bizarre to have locally different incentives.'
The Audit Commission report, published last week, found wide variations in exception reporting, ranging from 2.5% to 15.1% within PCTs. It said if consortia were to monitor QOF performance, they would need ‘careful management' by the board, to ‘take suitable action to ensure patients are only exception reported for legitimate reasons'.
Andy McKeon, managing director of health at the Audit Commission, said: ‘Robust audit will be crucial to ensure payments are being properly and fairly made and patients get the benefits intended.'
Pulse has previously revealed the DH was planning tighter scrutiny of GPs' exception reporting and reported prevalence levels to prevent the QOF being ‘undermined' once revamped to focus on outcome targets. A DH spokesperson said this work was ongoing: ‘The current system needs to change.'
GPC negotiator Dr Chaand Nagpaul acknowledged there was controversy over exception reporting, but maintained it would still be needed in the future outcomes-based GP contract: ‘The numbers where outlying exception reporting is taking place are extremely small. There is no widespread evidence of gaming.'Dr Vautrey: consortia role in QOF management is 'under discussion' with the DH Paying GPs to improve quality