This site is intended for health professionals only

A nasty QOF

We GPs are used to being misled, misdirected and mystified, but to experience the lot in one paragraph takes some beating.

I refer to a recent GPC update to LMCs. It summarises NHS England’s plans for practices for the rest of the year and yes, I know you’re nodding off already, but that’s sort of the point. We’re deluged with so much information, while getting so much busier, that shockers like this might pass through unnoticed.

So, I refer you to the para on QOF arrangements which, to summarise the summary, states that QOF resumes from 1 July (see, you missed that, didn’t you?) and that there will be a focus on influenza and smears, with a doubling of their points value to 59. And to explain my reaction:

We always knew that Covid could cause a nasty QOF

Mystified – because I don’t get the maths. While the flu/smear points have doubled, the total number of points available is the same as before (567). How do you suppose that works? You don’t think they’ve recycled points from elsewhere, do you, and not told us? That’s not like them.

Misdirected – because we’re being pointed to work of questionable value. Why the obsession with smears? I realise there’s some catching up to do, but that applies across the board. Someone, somewhere, should do a study on proactive care and the potential benefit to each individual of each activity: a smear versus an opportunistic BP versus quick smoking advice etc. I’m guessing here, but I reckon that, measured per individual, the likely benefit of a smear must be low, especially when balanced against the fact that it’s something that has to be done f2c (face to cervix).

Misled – because I’m looking at a letter from NHSE dated 17/3/20. This states that income will be protected if routine contracted work has to be substituted because of the pandemic. ‘This does not prevent us from continuing to measure activities (for those undertaken with QOF) but it ceases to put 2020/21 income at risk’. Or if you’d prefer, a letter from the GPC dated 19/3/20 stating, ‘NHS England has committed that QOF income for practices for 2020/21 will be protected’.

That’s hard to square with this repurposed QOF and the new comment that any payment for the refocused QI segment ‘will be conditional on practices working to these revised requirements’.

Hopefully that’s woken you up. That said, we always knew that Covid could cause a nasty QOF.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at