There is nothing good in these plans for GPs. It is worth remembering that most of the things in QOF that are to be withdrawn were put in for a reason in the first place. Overall, there is a bit of a lack of specifics – this looks much more like a high level political wish list than an actual contractual proposal.
The DH suggests there will be fewer than 1,000 points in QOF after the removal of organisational domain. This domain includes things such as meeting the PCT pharmacist, agreeing three targets for the year and taking blood pressure in all patients over 45 years old.
Struggling practices will lose some cash under the plans to increase QOF thresholds, and each patient will be worth a bit less. And it is likely to increase exception reporting.
Cutting the default time for QOF indicators from 15 to 12 months will have an effect on the work practices have to put in to get points. They will have to become a lot stricter to ensure patients with reviews due in March do not come late, and those due in April do not come in early. The ‘sweet spot’ for reviews will move from the Spring to the Autumn.
Having said that, some things will not change that much. The NICE recommended indicator changes are not that exciting – although what remains to be seen is how points are allocated. Paper shuffling will continued to be well represented in the QP indicators.
The proposed adjustments to average list size are really unclear. For reasons best known to GPC negotiators, the contract was negotiated per average practice rather than per patient. The use of the average list size was to try to convert the per practice payment to per patient.
There is really no sensible reason to play around with this unless the Government wants to vary the amount per patient. The average list size is increasing (fewer single handers, more mega practices) – does the Department of Health intend that the payment per patient will go down because of this? It really is not clear.
This is not so much a proposal as a battle salvo.
Dr Gavin Jamie is a GP in Swindon, Wiltshire, who runs the QOF Database website.