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Government consultation asks whether QOF should be scrapped

by Sofia Lind
15 December 2023

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The Government has launched a three-month public consultation that poses the question whether QOF should continue to form part of GP income.

It is expected to form the basis of negotiations for the 2025/26 GP contract, which will aim to bring major change for general practice after minimal changes for next year.

The first question in the consultation considering the future of GP incentive schemes, launched yesterday, asks respondents whether ‘incentives like QOF and IIF should form part of the income for general practice’?

But the consultation also considers improvements that could be made to the schemes, including introducing relative rather than absolute improvement targets.

For instance, GP practices have struggled with stringent targets for childhood immunisations leaving some practices without payment despite extensive work to reach out to reluctant families.

The Government thinks ‘absolute thresholds plays a crucial role in bringing all practices closer to nationally agreed standards, helping to ensure that the NHS is delivering value for money’, according to the document.

‘But, if a target is set, say at 85%, and practices achieve this target, it could be argued that the 15% that are missed might be those harder to reach that would have benefitted most from the intervention,’ it adds.

‘The use of relative improvement targets could acknowledge the varying starting positions and populations of individual practices.’

The Government also wants to know if patient continuity of care could be improved by being included as an incentive.

It proposes there ‘could be scope for an incentive scheme to encourage continuity of care using either regular patient survey data or general practice record data to measure achievement’.

‘However, we also recognise the importance of patient choice and clinical judgement in identifying which patients need or want continuity of care, and respecting that some patients may prioritise speed and convenience of access over seeing a specific professional,’ it adds.

In addition, the consultation suggests GPs could be incentivised for reducing pressure on hospitals.

‘We believe general practice can help to reduce pressures on the rest of the health system,’ the document says.

‘For instance, through effective management of long-term conditions, general practice can reduce the risk of unplanned hospital admissions.’

The consultation also asks whether:

  • patient experience of access could be improved by being included in incentives
  • ICBs could have more power to determine incentives and funding, based on local needs
  • incentives should be measured differently, including via clinical coding, clinical activity, or clinical outcomes – recognising that practices can’t solely determine clinical outcomes
  • incentives could be simplified to reduce admin burden.

The document said the Government recognises incentives as ‘a valuable tool for effectively allocating resources towards priority clinical areas’ but they also ‘recognise that QOF has limitations and can take focus away from non-incentivised areas of clinical care, slowing down rate of improvement in quality for other conditions’.

Launching the consultation, primary care minister Andrea Leadsom stressed the improvements brought to date by QOF and IIF, adding: ‘I am incredibly grateful to general practitioners and their staff, who have performed highly against QOF and IIF targets in the face of increasing demands, complex medical cases and evolving patient expectations.’

‘As we navigate these pressures, and as the healthcare landscape evolves, we must ensure that any incentive schemes within primary care continue to serve the best interests of our patients.

‘The current schemes need to adapt and respond to the changing needs of our population and the evolving priorities in healthcare, such as those outlined in the case for change and strategic framework for the major conditions strategy.’

She added that the Government is ‘committed to listening to your views, considering your recommendations, and making evidence-based decisions that prioritise the best interest of our patients and our healthcare system’.

‘Together, we will ensure that any future incentive schemes in primary care will continue to be effective tools in our mission to provide the highest standard of healthcare for all.’

QOF was established as part of the seminal 2004 GP contract as an optional incentive framework for improving quality of clinical care. However, due to the large sums of money linked to the scheme in reality GP practices are left with little choice but to participate.

Meanwhile, the Investment and Impact Fund (IIF) was launched as part of the PCN DES in the 2019 GP contract, although it was first fully operational in 2022/23 due to the pandemic.

For 2023/34, indicators were reduced from 36 to five, in a major shift towards targets linked to patient access.

The consultation will close at 11:59pm on 7 March 2024. To respond use the online consultation survey.

Key questions in full

  • Do you agree or disagree that incentives like QOF and IIF should form part of the income for general practice?
  • Do you agree or disagree that patient experience of access could be improved if included in an incentive scheme?
  • Do you agree or disagree that patient choice could be improved if included in an incentive scheme?
  • Would relative improvement targets be more effective than absolute targets at delivering improvements in care quality while also addressing health inequalities?
  • To what degree, if any, do you think that ICBs should influence the nature of any incentive scheme?
  • Do you agree or disagree that there is a role for incentive schemes to focus on helping to reduce pressures on other parts of the health system?

Source: DHSC

A version of this story was first published in our sister publication Pulse