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QOF system for GP payments should be scrapped, says RCGP chair

by Caitlin Tilley and Costanza Potter
18 March 2022

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The QOF system for GP payments should be scrapped, RCGP chair Professor Martin Marshall has said.

The current system ‘doesn’t make sense whatsoever’, he added.

Professor Marshall made the comments during an evidence session held today for the health and social care committee’s inquiry into the future of general practice, led by former health secretary Jeremy Hunt.

When asked by Mr Hunt whether it is ‘time to scrap QOF’ in England, Professor Marshall said: ‘Yes, from a college perspective, I think we should.’ 

He added: ‘When QOF was introduced in 2004, I think it served some really important functions. It systematised care [and] it produced a more team-based approach towards long-term condition care. That was good. 

‘But now we see the downsides. Particularly the kind of the bureaucratic and low trust approach towards managing professional behaviour and the inflexible approach far outweigh any benefits.’

A ‘different kind of contract’ with ‘higher trust’ and less ‘box-ticking’ that enables GPs to ‘make the right decision’ for their patients and local context is ‘fundamentally important’, Professor Marshall said.

He told MPs: ‘If I just give you a practical example – I’ve got to give the same attention, according to QOF, to an asthmatic who is really well managed, maybe not even taking regular medication, as I do to an asthmatic who’s really poorly controlled. 

‘The incentives are to deliver the same gear to both of them. It doesn’t make sense whatsoever. That’s why we need to be able to use our professional judgement to prioritise with the greatest clinical need.’

However, BMA England GP committee deputy chair Dr Kieran Sharrock argued that QOF should not be scrapped but ‘simplified’.

He said: ‘I don’t think it should be scrapped. [But] it certainly needs to be simplified and it certainly needs to build in measures that look at deprivation.

‘If you cannot recruit, you can’t provide good care and that then worsens health inequalities because you’re not being funded through QOF for giving good care.’

He added: ‘You need to find some way of incentivising those parts of QOF that can be delivered and making it more flexible and more simple, so it’s not so bureaucratic.’

Also speaking at the evidence session, Health Foundation senior policy fellow and GP Dr Becks Fisher said it is clear ‘QOF hasn’t necessarily achieved all it was hoping to’.

However, she added that ‘whether or not QOF should be abolished isn’t something that Health Foundation holds a particular position on’.

Mr Hunt suggested that QOF data could continue to be collected to ‘understand whether quality and safety standards are being met’, but that payments could follow a more ‘capitation-based model’ taking into account factors such as age and deprivation rather than being linked to ‘very specific outcomes in QOF’.

It comes as NHS England warned in December that payment for QOF and IIF ‘may be made later than usual’, as it set out the details of the temporary contract change aimed at freeing up GPs for Covid boosters.

NHS England also revealed parts of QOF and the IIF would be suspended and income-protected until next month to free up GP capacity for delivery of the expanded Covid booster programme.

Speaking at the evidence session, Dr Sharrock also warned that PCNs have ‘worsened’ health inequalities.

And Dr Sharrock and Professor Marshall called for all health professionals working in secondary care to spend ‘at least’ a year working in general practice as part of their training to reduce ‘inappropriate workload transfer’.