Government asks if IIF should be scrapped in consultation

The Government has launched a public consultation which poses the question whether IIF should continue to form part of GP income.

It is expected to form the basis of negotiations for the 2025/26 GP contract, which will aim to bring major change for general practice after minimal changes for next year.

The first question in the consultation considering the future of GP incentive schemes, launched today, asks respondents whether ‘incentives like QOF and IIF should form part of the income for general practice’?

It also asks if respondents agree or disagree that a PCN-level incentive scheme like IIF encourages PCN-wide efforts to improve quality.

The consultation also acknowledges that both QOF and IIF can become ‘tick box exercises’ that ‘distract clinicians from focusing on the needs of their patient and using their clinical judgement’, and asks what opportunities there are to simplify and streamline such schemes.

It also asked if  respondents believe there is a role for incentives to reward practices for clinical outcomes measured at PCN or place level.

IIF indicators were introduced in 2019 under the Network Contract, but the majority were suspended in 2020-21 to 2021-22 due to Covid.

2022-23 was the first year that IIF had been fully implemented, but earlier this year NHS England announced it would slash the number of indicators from 36 down to 5 and re-targeted funding to focus on improve patient access and experience.

The consultation considers further improvements that could be made to the schemes, including introducing relative rather than absolute improvement targets.

For instance, GP practices have struggled with stringent targets for childhood immunisations leaving some practices without payment despite extensive work to reach out to reluctant families.

The document says: ‘The use of absolute thresholds plays a crucial role in bringing all practices closer to nationally agreed standards, helping to ensure that the NHS is delivering value for money. But, if a target is set, say at 85%, and practices achieve this target, it could be argued that the 15% that are missed might be those harder to reach that would have benefitted most from the intervention.

‘The use of relative improvement targets could acknowledge the varying starting positions and populations of individual practices.’

The consultation also asks whether:

• patient experience of access could be improved by being included in incentives
• ICBs could have more power to determine which incentives/how much funding, based on local needs
• incentives should be measured differently, including via clinical coding, clinical activity, or clinical outcomes – recognising that practices can’t solely determine clinical outcomes
• incentives could focus on reducing pressure on secondary care
• incentives could be simplified to reduce admin burden

The document said the Government recognises incentives as ‘a valuable tool for effectively allocating resources towards priority clinical areas’ but they also ‘recognise that QOF has limitations and can take focus away from non-incentivised areas of clinical care, slowing down rate of improvement in quality for other conditions’.

Launching the consultation today, primary care minister Andrea Leadsom stressed the improvements brought to date by QOF and IIF, adding: ‘I am incredibly grateful to general practitioners and their staff, who have performed highly against QOF and IIF targets in the face of increasing demands, complex medical cases and evolving patient expectations.’

‘As we navigate these pressures, and as the healthcare landscape evolves, we must ensure that any incentive schemes within primary care continue to serve the best interests of our patients.

‘The current schemes need to adapt and respond to the changing needs of our population and the evolving priorities in healthcare, such as those outlined in the case for change and strategic framework for the major conditions strategy.’

She added that the Government is ‘committed to listening to your views, considering your recommendations, and making evidence-based decisions that prioritise the best interest of our patients and our healthcare system’.

‘Together, we will ensure that any future incentive schemes in primary care will continue to be effective tools in our mission to provide the highest standard of healthcare for all.’

QOF was established as part of the seminal 2004 GP contract as an optional incentive framework for improving quality of clinical care, however due to the large sums of money linked to the scheme in reality GP practices are left with little choice but to participate.

Since its launch it has seen annual changes but the current scheme consists of 76 indicators, each with a specific target for achievement.

Additional reporting by Jess Hacker