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Q&A: How national average list size affects the size of QOF payments

What is the point of CPI?

The value of a QOF point is partly adjusted by the size of a practice. This is to ensure that a practice with, for example, 10,000 patients will receive twice as much as a practice with 5,000 patients with all other things – achievement levels and prevalence rates – being equal.

The Contractor Population Index is the mechanism used to compare a specific practice list size with an average list size – and therefore calculate the value of a QOF point for that practice.

How is it calculated and why does it matter to my QOF payments?

It is calculated by dividing the specific practice list size by the national average practice list size. This means that the larger the national average practice list size, the smaller the CPI – and therefore the smaller the actual value of a QOF point.

As one GPC negotiator put it, if all practices in England decided to merge into one, and the value of an average QOF point didn’t change accordingly, then that practice would receive the same as an average practice currently does – but spread around every GP in England.

Why does the average list size keep going up?

The trend, as is evident in yearly statistics, is for the number of GP practices to reduce (last year by 1.6%), with the remaining practices left with larger patient populations as a result. If predictions for further consolidation in the profession are accurate, the national average list size will only continue to rise.

What changed in the CPI calculation in 2013?

Since the implementation of the 2004 GP contract and until 2013, the national average list size value used was that of the 2002 census. Understandably, since it would erode the value of QOF, the GPC had been unwilling to agree to a change but NHS England seized the opportunity of pushing through its desired changes to the CPI calculation with the 2013/14 contract imposition.

Since then, NHS England has decided that the national average list size should be updated every year, using data from the beginning of the first quarter before the start of the financial year in question. So, for example, for 2013/14 QOF payments the CPI is calculated using the average list size on 1 January 2013.

How was this change meant to be cost neutral?

When announcing this change with the 2013/14 contract imposition, the Department of Health stated that it would be putting up the value of a QOF point by the same value that the national average list size would be uprated as of 2013.

What is the current disagreement between the GPC and the Government?

In the end, the final calculation of the national average list size for 2013 ended up being 6,911 – 17.3% higher than the 2002 figure and the value of a QOF point rose accordingly.

However, Pulse has learned that no such uprating of the QOF point value has been agreed for the 2014/15 GP contract, despite Government documents having revealed that national average list size has been estimated at a 2% increase on 1 January 2014, at 7,052.

How will this affect me?

Unless the GPC can convince the Government to also increase the QOF point value by 2% – the same value that the national average list size will rise by – GP practices stand to see the value of their total QOF achievement for 2014/15 reduced by 2% – or around £2,000 for the average practice.