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Will QOF opt-out deals sabotage the national contract?

For GP practices in Somerset, it must have seemed like Christmas had arrived 11 months early.

They were informed last month that their local CCG had struck a radical agreement with NHS England to ‘switch off’ reporting of their QOF achievement for the rest of the financial year.

Practices will still be paid, based on their QOF performance over the same period in 2012/13. But instead of chasing national targets, they will be expected to participate in a new project to redesign GP services – and will be liberated completely from the yoke of the QOF in April, if the redesign goes ahead.

While the deal was met with glee by local GPs, the GPC warned that it ‘drives a coach and horses’ through the national contract that negotiators thrashed out with NHS England just weeks ago.

The reaction from Family Doctor Association chair Dr Peter Swinyard was typical of most of the profession outside Somerset: ‘I am doing an afternoon of QOF code-checking rather than clinical work today. Can I stop please?’

The answer from NHS England was an emphatic ‘no’. It has backed the move in the South-West, saying it is an ‘innovative solution to commissioning primary care’ – but in other parts of the country, local area teams have rejected bids from GPs looking to negotiate similar deals.

GPs working under two additional area teams have won some concessions. They have been given permission to abandon chasing QOF points that will become redundant in April, in favour of making an early start on the unplanned admissions DES. As Pulse went to press, GPs in Devon, Cornwall, Lincolnshire, Leicestershire and Rutland had been told they will be reimbursed until April for QOF indicators due to be removed from the framework in 2014/15, but will not be expected to report achievement against those targets. However, this flexibility has not been extended to GPs in the rest of the country.

Pulse has learned that CCGs in Birmingham, Cumbria, Kent and North Yorkshire have all requested a similar suspension of the QOF, but so far none has been able to reach an agreement with their local area team.

Dr Jonathan Wells, chair of NHS Redditch and Bromsgrove CCG, says he immediately approached his local area team – Arden, Herefordshire and Worcestershire – and Birmingham LMC.

Dr Wells says: ‘The area team said “no way” and expressed surprise at the Somerset decision – they pointed to the single operating model.’

NHS Cumbria CCG also initiated informal discussions to try to cease work on QOF indicators due to be retired in April, but a deal looks unlikely. A similar request from GPs in North Yorkshire has been turned down because the request came ‘too late’.

In Kent, NHS Thanet CCG is hoping to suspend the QOF from April to work on other projects but, while the CCG claimed its local area team had been ‘supportive so far’, the team played down the move and said no official discussions had taken place.

Dr Tony Martin, chair of Thanet CCG, says: ‘We are looking at how we can accelerate community-based care as an alternative to hospitalisation.

‘The option of a Somerset-type deal is certainly something we will be asking our members to consider and [we] have had outline discussions with the area team. We would of course need members’ agreement and to work with the LMC.’

‘Hugely dangerous’

This fraying of the national contract has alarmed the GPC, with negotiators warning the reduction in QOF chasing could backfire if practices eventually end up with worse terms than before.

While the GPC supports suspending QOF work that will not be renewed in April, it has expressed major concerns about the implications of abandoning the framework entirely.

Dr Nigel Watson, chair of the GPC’s commissioning subcommittee and chief executive of Wessex LMCs, says: ‘The QOF is a significant part of GP income. The work done nationally to agree on it cannot be replicated locally and moving, potentially, to CCGs deciding what goes in the QOF is hugely dangerous. I’m not sure the LMCs have the capability or capacity to negotiate the QOF on an annual basis.

‘I’m quite surprised at this, with the “single operating” framework controlled by NHS England headquarters. We were told area teams were part of a single organisation for England. This seems to be driving a coach and horses through it.’

But some GPs argue the move is long overdue. Dr Robert Hodges, a GP in Gloucester, says: ‘None of us are denying practices the chance to do QOF, but the option to do something else is a huge step forward. Quite frankly, we’re fed up with bloody London solutions to non-existent local problems.’

Read more here: Q&A: QOF suspensions