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Local QOF opt-outs will erode GPs’ negotiating power

The introduction of the QOF provided a successful incentive for practices to review their provision of care and, where appropriate, make changes, which created better outcomes for patients.

However, over the last few years, the QOF fell out of favour when it became overloaded with indicators many felt served little purpose for the GP or patient, turning the pursuit of QOF points into a tick-box exercise that interfered with consultations.

Therefore, a key aim of last year’s contract negotiations aims was to reduce the burden on GPs by removing QOF indicators of lower clinical value, and focusing on indicators that demonstrate clear benefits to patients.

I currently work as the CEO of Wessex LMCs, an organisation that has presented the contract changes to over 700 GPs and practice managers and found that the overwhelming majority supported them.

Local contract variation

We need contracts to be robust and consistent, but they must also meet the needs of the local population. Most GPs support this model, especially as local negotiations are nothing new for GPs, and there are good examples that the profession still relies – PMS contracts and local enhanced services (soon to be known as local contracts) are a couple of historic examples.

In April 2013 the Health Act reforms created a single organisation for England for commissioning general practice at a national level. The GPC now negotiates the GP contract annually (including how much QOF work GPs will do) with NHS England. Some commissioning work has been devolved down to local area teams (LATs), who act as local ‘branches’ of NHS England.

It was therefore a surprise to find that the local area teams in Somerset, Devon and Cornwall had negotiated with its CCGs and LMCs for GPs to stop working on the QOF indicators that will be removed in April 2014. Not only that, but the LAT also asked GPs to start work towards the agreed contract changes for 2014/5 before the contract starts, including the admissions avoidance DES and the named GP initiative for patients over 75.

The Devon and Cornwall scheme was essentially introducing the April changes early which I would broadly support as this makes sense and is what we negotiated. 

But I have concerns about Somerset abandoning national negotiations to have a purely local scheme.

Most GPs are now aware of this agreement, and many commend it. A few other LATs including Devon and Cornwall have opened discussions with their LMCs about the possibility of reaching the similar agreements, although the vast majority have avoided negotiating such an agreement because of the short timescales that would be necessary to implement it before March 2014.

Local agreements depend on the relationship between the LAT, the CCG and the LMC.  Where this is good, the outcomes might be positive but where relationships are less positive this is a significant amount of money to put at risk.

But the main issue is that local variation could further erode the power the GPC has to negotiate the contract at a national level – something we must avoid at all costs. Going forward, LMCs and the GPC need to work much more closely for the greater good of the profession.

The GPC will continue to ensure QoF is clinical relevant and adds value to the care and outcome for patients and ensure that it does not return to a tick box exercise. I still think there are more indicators which could be removed and added to the global sum.

With the current challenges the NHS faces – rising A&E attendances, increased admissions and a growing number of frail and vulnerable elderly – general practice needs to be seen as a solution. To achieve this, GPs need more resources to provide services at a practice- or community level, but this cannot be achieved by introducing new work funded from existing resources.

Dr Nigel Watson is CEO of Wessex LMCs and a GP in New Forest.