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GPs set for new indicators on depression and rheumatoid arthritis

The Department of Health has set out its demands for revisions to next year’s GP contract with a host of proposals to reshape the QOF - and warned it may try to impose changes if it is unable to reach agreement with GPC negotiators.

In an announcement this morning, the DH published a series of proposed changes to the contract after claiming that talks with the BMA had broken down.

Its proposals for the QOF include accepting all the changes recommended by NICE to the framework, including new indicators on cancer, depression and rheumatoid arthritis, and reducing the size of the whole framework by 139.5 points.

The DH also stated its intention to stop additional rewards for the organisational domain of QOF, which it said ‘should be part of any good health organisation’, and reallocate this money into other areas.

It said this could include ‘ensuring that more patients benefit from best practice in areas such as keeping blood pressure low and reducing cholesterol levels, especially those in most need or hardest to reach’.

Health secretary Jeremy Hunt said the DH wanted the BMA ‘to work with us’, but warned the DH ‘will not back away from making changes that will deliver better care for patients’

He said: ‘Putting patients first is our priority and I make no apology for this. The GP contract needs to change so that it further improves care for patients.’

‘Our population is living longer and an increasing number of people have long term conditions. By 2018 those with one or more long term condition is set to rise to 2.9 million. Our proposals will help ensure that we provide the very best care and support possible for those at most risk of life threatening conditions. We want to drive up standards for all and want the contract to reflect the most up-to-date expert guidance and excellent standards of care.’

The DH announcement did not include specifics of its proposed new indicators, but hinted at a wide-ranging change in incentives: ‘The proposals put to the BMA include possible new quality improvement schemes for diagnosis and care of people with dementia, care for the most frail or seriously ill patients, patient access to online services, and support to help people with long term conditions better monitor their own health.’ It was not clear if all of these would fall under the QOF or could include changes to enhanced services and other GP funding streams.

(Read a full list of NICE’s recommendations for the 2013/14 QOF here).

GPC negotiator Dr Chaand Nagpaul said the proposals would add ‘a huge quantum of workload into general practice’. 

He said: ‘This feels like an onslaught of work being absorbed. The message we’ve had from GPs was to lessen their workload as part of negotiations. This clearly is going to increase the workload to a huge degree, to replace the entire organisational points.

‘It utterly fails to understand that the whole ethos of the organisational indicators of the QOF, which is not about simply rewarding to achieve standards but to pay for the infrastructure and on-going workload costs of running an organisation. So to totally disregard this is a huge issue.

He added: ‘There are principles that have been broken in these proposals, and one of them is that GPs need running costs to deliver on the organisation of their practices. That was the whole ethos. It is a payment for the costs of running a GP surgery to specified organisational standards. That whole concept is lost if you just remove those points.’