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QOF revolt in Somerset puts NHS England on the spot

One of the intriguing sub-plots of the NHS reforms has been the extent to which NHS England has represented a centralising force, apparently pulling against localism even as the rest of the health service evolves into regionalised alphabet soup.

GPs were promised a ‘single operating model’ for the commissioning of primary care, and while there are 27 local area teams around the country, unlike PCTs they have no independent boards, share overlapping functions and must work to a ‘common model’.

Until now, the authority of Quarry House has hardly been tested, with NHS England in the centre taking a strong lead in areas of interest to GPs such as payments, and Christmas opening, and local area teams falling into step.

But all that appeared to change in dramatic fashion on Monday, when Pulse revealed that one local area team in the south west appeared to be effectively abandoning parts of the national GP contract

GPs in Somerset were told by their CCG that they could, with the blessing of their local area team, stop reporting QOF data for the rest of the year and instead expect to be paid based on 2012/13 achievement – and that the time saved could be used as ‘thinking space’ to ‘redesign’ QOF from April.

Elsewhere, the GPC reported that Devon and Cornwall CCGs had also negotiated an agreement with local LMCs to abandon chasing QOF points that would become redundant in April anyway, with the implementation of the 2014 contract.

Radical stuff, and not by any means unwelcome for many GPs. (‘Blimey, and I thought common sense had deserted us’ was the first comment on our story, while GPs in Somerset have been heavily involved in the process). But it also poses a massive challenge to NHS England’s central authority and any notion of a single operating model, and raises a series of questions.

Does the local area team for Somerset have the authority to unilaterally suspend or amend parts of the GP contract? Is the move supported by NHS England as a whole? Are other areas doing likewise? And what does it mean for the national contract and the GPC’s role representing GPs?

As GPC deputy chair Dr Richard Vautrey put it, not unreasonably: ‘There’s a real risk that practices find themselves in the same situation that PMS practices now find themselves, where initially it sounds like a good deal to have more of a local contract with favourable conditions but it’s much more difficult then to get back to national arrangements if they find they are no longer getting favourable agreements and things have deteriorated.’

The revolt in Somerset hasn’t just caused consternation in BMA House – it’s caused confusion among CCGs as well. Dr Jonathan Wells, chair of Redditch and Bromsgrove CCG, immediately emailed his area team and LMC after reading the story, only to be told ‘no way’. Dr Wells’ area team, we are told, ‘expressed surprise’ at Somerset’s decision

In fact, the decision as a whole seems to have caught NHS England flat-footed. Pulse contacted NHS England’s central office at lunchtime on Monday when the story broke, but the organisation has yet to issue any kind of statement on the direct challenge to its authority. In Somerset, the local area team has also yet to comment, although the CCG there has issued a formal press release reiterating its stance. 

The only comment we have been able to elicit from any part of NHS England comes from its Devon, Cornwall and Isles of Scilly area team, whose spokesperson said: ‘The NHS England area team in Devon, Cornwall and Isles of Scilly, alongside the three CCGs in Devon and Cornwall, Devon Local Medical Committees and Cornwall & Isle of Scilly LMC, are working together to agree the replacement for the QOF framework. These negotiations are nearing completion and further information will be available shortly.’

The rebellion may be spreading. How NHS England responds may tell us a lot about the future of localism in the new-look NHS.

Steve Nowottny is the editor of Pulse. You can email him at and follow him on Twitter @stevenowottny.