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QOF may shrink to ‘3-4%’ of GP practice income as review ‘nears completion’

by Carolyn Wickware
3 May 2018

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The QOF in England looks set to be retained, but could be slashed back to just 3-4% of practice income, according to a GP member of the review group.
RCGP vice chair Professor Martin Marshall told Pulse that rather than a current 8-10% of practice income, the QOF should be stripped back to a ‘much smaller set of indicators’, under plans that are being pushed by the RCGP.
The interview followed a speech at the Londonwide LMCs Conference today, in which Professor Marshall said the QOF was ‘unlikely’ to be scrapped entirely by NHS England as the review group’s work was ‘coming to an end’.
The remainder of the funding could be ploughed into a national ‘quality improvement programme’, that would allow GPs to choose from a ‘menu’ of other services – such as for example obesity services – for which they would get paid, Professor Marshall said.
‘It’s very unlikely that England will just abolish it and leave a vacuum in the way Scotland did,’ he told the conference – adding that this was ‘a much more sensible way of taking the system forward if GPs are willing to take the shake-up in the system that that would require’.
Explaining the proposals to Pulse, he added: ‘If we cut QOF down to a much smaller set of indicators – maybe only 3% or 4% of practice income – then the rest goes into a quality improvement programme, the quality improvement programme would essentially be a menu that practices could choose from.’
He said that this would allow practices to choose what services they want to offer from obesity to health inequality.
‘There will be a range of perhaps 10-15 programmes and you might choose one or two a year, and then you get paid a sum of money just for doing that,’ he said.
The changes to the QOF were due to come in from this year but have been subject to significant delays. According to Professor Marshall, the changes will now be subject to 2019/20 GP contract negotiations and a consultation with the profession.
The news comes despite health secretary Jeremy Hunt expressing a wish to get rid of the payment-per-performance scheme, and as NHS England’s chief said it had reached the ‘end of its useful life’.
Professor Marshall said the new system would be ‘a high-trust, profession-led, quality improvement scheme rather than a low-trust, government-led quality assurance scheme’.
He said the RCGP, which sits on the QOF committee alongside the BMA’s GP Committee, NHS England and other stakeholders, had pushed for the idea of a scaled back QOF.
An RCGP spokesperson said: ‘The QOF review provides a number of opportunities and we have made it clear that we would like to see a quality improvement component introduced as part of this.’
But they stressed that ‘while the college sits on the advisory review group with the GPC, it will be the sole responsibility of the GPC to negotiate the content of the contract’.
The GPC has previously said it wanted QOF to be ‘retained but reformed.’
Scottish GPs are no longer participating in QOF, while QOF in Wales has been reduced to disease registers.
Among GPs responding to a Pulse survey last year, nearly half were hoping to see it abolished.
This story was first published on our sister publication Pulse.