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Doubts over abolition of QOF as BMA continues to negotiate indicators



Exclusive GP leaders have met with NHS clinical chiefs to discuss altering QOF diabetes indicators next year, casting doubt on whether the QOF will be abolished in next year’s GP contract, Pulse has learnt.

NHS England diabetes experts have held talks with the BMA’s GP Committee and NICE to look into how indicators could incorporate more flexible targets to ‘individualise’ treatment and said that the proposals could be published ‘in a few months’.

But this comes after NHS England chief executive Simon Stevens has said that the QOF has reached the ‘end of its useful life’, while the 2017/18 GP contract announcement included a stipulation that a working group would be set up ‘to discuss the future of the QOF’ after 2018.

Other GP leaders said that these negotiations over indicators suggest that the QOF will continue beyond this year.

Speaking to Pulse, NHS England associate clinical lead on diabetes Dr Partha Kar said his team had met with GPC to discuss the option to introduce more flexibility in the targets to help GPs tailor treatment better, for example in older, frail people in particular.

Dr Kar said: ‘There is a bit of a “baby and bathwater” thing here with cutting QOF. We met with the GPC officially, as we accept that there are some bits of QOF that wear you down, but there are some bits of QOF a diabetes patient does need.

‘For example on HbA1c, can we say, if the patient is over 75 and has frailty their target to hit the marker is 9%, not 6.5%. NICE says there is flexibility to do that, so we could put that in the QOF. ‘

He added: ‘That discussion is going on with BMA GP group at the moment – hopefully that will come out in the next few months or so.’

GPC confirmed to Pulse it has met with NHS England and NICE bosses on diabetes targets specifically and said this would be part of ‘any future review of QOF’.

Dr Richard Vautrey said: ‘We have met with Dr Kar and raised our concerns that some aspects of QOF, including the current diabetic treatment targets, make it hard to individualise treatment for some patients, particularly the frail elderly.

‘This is something we will be considering as part of any future review of QOF.’

Dr Vautrey stressed that ‘all that has been committed to for the coming year is for that negotiation to take place’.

Asked if this was meant the QOF was likely to continue in 2018/19, Dr Vautrey said: ‘I don’t think we can say either way… there are many who will still want to monitor the quality of care delivered and want to extract data relating to that and what we want to very careful of is we don’t end up with something that leaves practices in a worse situation.’

Dr Peter Swinyard, chair of the Family Doctors Association, said: ‘It’s very strange isn’t it, because we have been sort of promised that the QOF is going to die.’

He added: ‘If you are going to carry on with the QOF, then yes make it more flexible but if you’re not, well… Nero was very good at playing the violin wasn’t he.

‘I’d much rather the money was just recycled and available for practices.’

QOF hokey cokey

The current revelations come despite NHS England recently saying it was ‘committed in principle’ to scrapping QOF after its chief Simon Stevens stated that QOF had ‘reached the end of its useful life’ and would be phased out of the GP contract by 2018. 

The GPC said at the time it supported Mr Stevens’ comments and that they were in line with calls in its Urgent Prescription for General Practice to end the box-ticking and bureaucracy of QOF.

However, there have been talks of scrapping QOF for some time and health secretary Jeremy Hunt has repeatedly hinted at getting rid of the framework, in the 2016/17 contract agreement it was previously explicitly stated that negotiations for 2017/18 would explore the option to completely abolish QOF.