Exclusive: CCGs covering deprived areas will have their targets adjusted for the demographics of their populations, the NHS Commissioning Board has told Pulse.
The move comes after NICE revealed their final recommendations on the list of targets the quality premium for GP practices will be tied to, which included mortality for cancer and respiratory disease and patient experience of GP out-of-hours services.
GP leaders said many of the indicators would be outside GP's control because of population factors, but the NHS Commissioning Board promised they were looking at a ‘robust approach to case mix adjustment.'
The list of 44 indicators include reducing the number of people with dementia on antipsychotics, emergency admissions for conditions that do not normally require hospital admission and the proportion of patients ‘feeling supported to manage their own condition'
The Commissioning Outcomes Framework (COF) has been developed by the NHS Commissioning Board and NICE, and will form the basis of how the performance of CCGs will be assessed. This performance will dictate the quality-premium payments made to GP practices.
A spokesperson from the NHS Commissioning Board said: ‘The COF is still under development, however it is recognised that a robust approach to case-mix adjustment will be needed to weight achievement in accordance with the scale of the challenge.
‘CCGs will be held to account not only for the outcomes they achieve for patients through the COF, but also for other aspects of performance, such as financial management.'
Dr Mary-Louise Irvine, a BMA Council member and a GP in South-East London, said she thought the indicators should be piloted in order not to discriminate against GPs in deprived areas.
She said: ‘Even with case mix there is that usual dread that there won't be a proper understanding of GPs in deprived areas. We've got people living in overcrowded housing, in poverty, people that are moving around all the time so it's hard to follow up on their care.'
‘A lot of what leads up to these mortality risks are factors that start in childhood. It's really hard for any interventions in later life to change them. That doesn't mean we don't want to give great care.'
‘Anything which unfairly discriminates against GPs who need the resources the most is to be questioned. If my resources are shrunk it's more difficult to deliver good care. I think the indicators should be piloted and evaluated to get them right.'
