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Letter from Dr Laurence Buckman about GP contract negotiations

GP contract update 1: What will the QOF changes mean for your practice finances?

In my letter to the profession of 25 October I set out the raft of changes the government is proposing to impose from April 2013, following a consultation.  The GPC is still waiting for confirmation of these changes but we know that practices need to understand now what is likely to happen to them so they can plan their services for next year and beyond. 

If the government’s plans do not change, and practices do not take on significantly more work, general practice could be seriously destabilised.  Here’s how: Threshold changes

Thresholds in QOF will increase in line with the upper quartile of average current achievement.  If practice achievement remains at current levels, the average practice[*] will lose £11,000 from their QOF income. This loss alone is very likely to wipe out any increase in contract prices for 2013 recommended by the Doctors and Dentists Review Body (DDRB).  At this point we cannot assume there will be any additional investment in the contract at all.

Removal of organisational points

The organisational domain will be removed from QOF. Regardless of whether this happens over one or two years, this will remove £20,000 from the average practice.  This revenue stream provides critical funding for practice running costs.  The government’s insistence that GPs will be able to earn this resource back through new QOF and DES work is immaterial as practice capacity is severely restricted and existing organisational work must continue.

This is serious.  Although the government’s proposals may yet be subject to change, now is the time to begin to plan for their impact.  In the coming months, all practices will need to look hard at their accounts and consider what changes will need to be made to make ends meet next year. 

I will write to you again very soon with analysis of what the government’s other proposed changes could mean for you and your patients. 

For the average practice*:
Threshold changes                      - £11,000
Organisational points removal          - £20,000
TOTAL QOF LOSS                         - £31,000


The final total loss to practices will be determined by any contractual uplift made following the DDRB’s recommendations for 2013/14.

*The average practice in England has 6,651 patients.  Losses will of course vary according to practice circumstance and patient characteristics.