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NHSE warns QOF and IIF payments may be delayed under temporary contract changes

by Costanza Pearce
8 December 2021

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

In a letter sent to practices today, NHS England set out ‘temporary’ changes to the GP contract designed to support the expanded Covid booster programme, including outlining more details on the changes to QOF and the PCN IIF for 2021/22.

But it warned that QOF and IIF payments may be made ‘later than usual’ for 2021/22 ‘given that the proposed changes to the scheme are being made towards the end of the year’.

The temporary contract changes outlined that:

  • GPs should ‘focus’ on the four QOF vaccination and immunisation indicators, the two cervical screening indicators, the register indicators and the eight prescribing indicators, which will be paid based on practice performance.
  • 46 QOF points for new indicators ‘where there is no historic performance to use as the basis for income protection’ will be reallocated to ‘increase the total points available for the eight prescribing indicators’.
  • The remaining indicators ‘will be income protected using a methodology very similar to the one applied in 2020/21’.

The letter said: ‘Practices are expected to continue to apply their clinical judgement and deliver as much patient care in these areas as they can, with a focus on the highest risk patients, but their income will not be dependent on recorded QOF achievement this year for the income-protected indicators’.

The changes will apply to all practices and be reflected in an amended statement of financial entitlement (SFE), it added.

It said: ‘To be eligible for income protection, practices will need to agree with their commissioner a plan that will set out how QOF care will be delivered wherever possible, but with priority according to clinical risk and accounting for inequalities.’

NHS England will be working with the RCGP and the BMA to provide further guidance to practices, it added.

Meanwhile, the letter also set out changes to the PCN incentive scheme for 2021/22 – including that £112.1m funding for suspended indicators will be ‘repurposed’.

The three flu immunisation indicators and the appointment categorisation indicator will be paid based on PCN performance, while the remaining indicators ‘will be suspended and the funding repurposed’, it said.

It added that £62.4m will be allocated to PCNs via a ‘support payment’ to be paid on a ‘weighted patient basis’ and £49.7m will be allocated to a new ‘binary’ indicator paid on the basis of participation in the booster programme.

It reiterated that QOF and the IIF will restart in full from April 2022.

QOF

  • 46 QOF points for new indicators will be reallocated as there is ‘no historic performance to use as the basis for income protection’ – including the eight points for the new 2021/22 cancer indicators, 20 points for the new 2021/22 mental health indicators and 18 points from the non-diabetic hyperglycaemia indicator introduced in 2020/21 – to ‘increase the total points available for the eight prescribing indicators’
  • The four vaccination and immunisation indicators, the two cervical screening indicators, the register indicators and the eight prescribing indicators will be paid based on practice performance
  • The remaining indicators will be income-protected ‘using a methodology very similar to the one applied in 2020/21’ – most will be paid based on 2018/19 achievement, while those relating to diabetes and hypertension will be based on 2019/20 achievement since some were new in 2019/20
  • Income-protected points will be subject to a list size and prevalence adjustment ‘calculated in the usual way at year-end’
  • The quality improvement (QI) domain will be paid to practices in full
  • All activity should continue to be coded and aspiration payments will ‘continue as at present’
  • QOF payments may be made ‘later than usual’ for 2021/22 ‘given that the proposed changes to the scheme are being made towards the end of the year’

PCN investment and impact fund

  • The three flu immunisation indicators and the appointment categorisation indicator – ‘as the work is complete’ – will continue to be paid based on PCN performance in 2021/22
  • The remaining indicators will be suspended and the £112.1m in funding allocated will be ‘repurposed’
  • £62.4m of suspended indicators’ funding will be allocated to PCNs via a ‘support payment’ to be paid on a weighted patient basis, subject to confirmation from the PCN that it will be ‘reinvested into services or workforce’
  • £49.7m will be allocated to a new ‘binary’ IIF indicator, paid on the basis of all practices within a PCN being signed up to phase 3 of the Covid vaccination enhanced service as at 31 December 2021, remaining signed up until 31 March 2022 and ‘actively delivering’ the programme
  • Practices not signed up to the enhanced service would need to opt-in by 10 December 2021 and be assured to go live in early January to be eligible
  • Payment for this indicator will be made on a ‘registered list size basis after the end of the financial year’
  • If the commissioner agrees with ‘one or more practices that they should not participate’ in the enhanced service ‘as a result of wider access, performance or patient safety issues’ and in ‘exceptional circumstances’, then the PCN may still receive payment with those practices excluded from consideration
  • The payment ‘will not apply if any practice in the PCN otherwise declines to participate in the programme’
  • As with QOF, recording of all activity should continue but payment ‘may be made later than usual’

Balancing resources

NHS England said: ‘We recognise that balancing your resources this winter between the urgent needs of your patients, the management of long term conditions, and the vital task of vaccination and public health is a daily challenge. 

‘The measures in this letter seek to support your professional clinical judgement in balancing these considerations.’

It added that the new measures will support, GPs, PCNs and their teams to ‘progress this expansion of the vaccination programme alongside prioritisation of timely patient access to general practice services this winter’.

Last week, NHS England revealed that parts of QOF and the IIF will be suspended and income-protected until April to free up GP capacity for delivery of the expanded Covid booster programme.

It also expanded on the increased ‘financial support’ in the form of raised vaccination fees announced earlier in the week.

The health secretary last week promised that the Government was working to ‘free up’ GP time so they can dedicate themselves to delivering Covid booster jabs.

GP leaders had called for GPs to be freed up to focus on speeding up the Covid booster jab campaign – including by suspending QOF – and for NHS England to ‘guarantee funding security’ for GP practices until the end of March.

The Prime minister has announced a target for the NHS to offer booster Covid jabs to all over-18s within two months.

It comes as NHS England has today announced that people aged over 40 and in high-risk groups are being invited to book their Covid booster jabs three months after their second dose from today.

This story first appeared on our sister title, Pulse.

Category => Covid-19

Category => News


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