Making New Year’s predictions is a mug’s game. But (perhaps foolishly) Pulse is doing just that.
The QOF may have been one of the totemic features of the 2004 GP contract, but a Pulse investigation reveals it may soon be consigned to history.
We have discovered that 12 CCGs are looking at offering practices in their area an alternative to the QOF under co-commissioning, with some planning for this to be in place from April. They may retain some aspects of the framework, but they plan for all GP practices to say ‘bye bye’ to the national scheme and sign up for a new local contract.
CCG leaders see this as a landmark opportunity to better align the incentives given to hospitals and primary care services. And it would certainly seem to make sense to bridge the historic divide between both parts of the health service and have them working towards the same goals.
NHS England is championing the move, allowing CCGs who bid for full control of GP funding from April to jettison the framework without permission from local area teams.
But, of course, this all relies on the agreement of local practices. A Pulse survey last July found almost half of GPs would opt out of the QOF if their CCG offered an alternative. Some LMC leaders are actively championing a move away from the national contract.
The precedent has already been set in Somerset, where more than two-thirds of GP practices have ditched the QOF for an alternative regional scheme. GPs in the area say they are already noticing the benefits of being ‘liberated’ from box-ticking.
Not long ago, the QOF was regarded as a world-leading mechanism for remunerating practices for providing quality, evidence-based care to patients – but it strayed too far from its original remit.
After steady improvements in care during its early years, the positive impact of the QOF lessened, despite its growth as a proportion of practice income.
It became bloated, with many patient groups and lobbyists fighting for their pet cause to be included. NICE then took over the framework, contorting it to incentivise GPs to follow its clinical guidance.
The indicators became progressively more onerous and less evidence based. For instance, the inclusion of the PHQ-9 and GPPAQ questionnaires for depression and physical activity, and the infamous ‘quality and productivity domain’ undermined GPs’ professionalism and fatally eroded support for what was – at least initially – a decent idea.
The 2014 contract deal saw the tide begin to turn. Some 40% of QOF points were removed and the funds transferred to the global sum. The health secretary made the extraordinary claim that he’d get rid of the whole QOF ‘if he could’.
But it looks like co-commissioning may save him the trouble. If so, there would be far-reaching consequences for the whole GP contract – which is why the BMA is so opposed to the idea.
Negotiators argue that bidding farewell to the QOF will leave practices exposed and at the mercy of the vagaries of the funding system for CCGs. That is a concern, but confidence in the GPC to deliver a good deal for practices has been hit by recent experience.
Many GPs may prefer to take their chances on a local contract. If so, the demise of the QOF may just be the beginning of the end for the national GP contract.
2015 is going to be an interesting year.
Nigel Praities is editor of Pulse
