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Dr Gavin Jamie: ‘For many practices this could have a bigger effect than the withdrawal of the MPIG’

The Contractor Population Index, like most things that are working well, has not attracted much attention until now. Its purpose has been to make sure that the cash value of a QOF point takes into account the size of the practice. A practice with 10,000 should, all other things being equal, get twice as much for each QOF point as a practice with five thousand.

But changes and mistakes in how this is calculated has the potential of costing practices thousands of pounds.

Until April 2013 an ‘average’ practice in England was considered to have 5,891 patients (the three devolved nations used their own values). Effectively QOF was paid in blocks of 5,891 patients. In the first year of QOF a point was worth £120 per 5,891 patients, or just a shade over 2p per patient. This value gradually increased over the following years. It didn’t actually matter what an actual average practice list was, we were effectively being paid per patient. It simply made the contract easier to present when larger numbers were used.

Autumn 2012 probably represented the lowest point in relations between the GPC and the Department of Health, with a contract imposition looming on the horizon. In paragraphs 33-35 of the letter from Richard Armstrong in December 2012 it was proposed to change the 5,891 figure based on the actual average list size, stated as requiring an increase of 16% to 6,834 patients. The actual figure was to be calculated on the first day of January before the QOF year began.

In the long term, the trend is for average lists to rise if the population increases or smaller practices close. Of course if the cash value of a point stays the same it is spread between a larger number of patients and the value per patient will fall. For one year only there was to be an increase of 16% in the value of a QOF point to compensate. Mr Armstrong’s letter stated that ‘this would be a cost neutral change in 2013/14’. In the end, the average list size on 1 of January 2013 was 6,911 – an increase of 17.3% and the value of a point was increased in line with this.

However the CQRS system last week used the figure from January 2014 which was 7,052 patients. The error – to which NHS England has now admitted – in the calculation from CQRS would have represented a 19.7% increase on the old figure. For a 10,000 patient practice this would represent more than £3,500 loss on top. This is simply an incorrect interpretation of the rules and was sorted reasonably quickly.

This is not the end of the story however. This figure of 7,052 patients will be used for the QOF points in April 2015. There is no promise of cost neutrality then. In fact there is no proposal to increase the value of a QOF point at all. This means that a QOF point in 2015 will be worth over 2% less than it did this year. Even the new, slimmer, QOF is likely to be worth around 10% of practice income – meaning that a 2% loss will take away the majority of the 0.28% overall uplift awarded for 2014/15.

As the current regulations stand this would then become an annual event. As practices tend to become larger, the value of a point will drop. For many practices this could have a bigger effect than the withdrawal of the MPIG.

Dr Gavin Jamie is a GP in Swindon and runs the QOF Database website.