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by Dr Gavin Jamie
22 November 2013

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QOF: ‘Returning to its roots’

QOF expert Gavin Jamie digs into the nitty-gritty of this year’s GP contract changes. To him, this looks like the biggest change so far…

Did I say last year that that was the biggest ever change to QOF? Looking over the agreed changes for next year I have to say it again.

First the headlines. There will be 341 points removed from the QOF next year. The proposed threshold rises have been suspended for a year, and in one case (hypertension targets) they have been rolled back. There are no new indicators, or even significant alterations to the current ones.

Quality and Productivity indicators have gone in their entirety which will be a relief for all GPs who prefer not to spend their lunchtimes in an overcrowded meeting room.

There are a few tweaks to timescales which all either neutral or in practices’ favour.

Sound good so far?

Digging down into the details things start to look a little messier, as usual. Changes to the QOF have never really had much strategy behind them and it is difficult to say that the indicators have removed according to some grand plan. The result looks unbalanced and it may well take another year of negotiations to sort it out into something more rational. It will be interesting to see what the three other nations decide to do.

Thyroid disease has been removed completely. QOF historians (that might only be me) will note that this is the first clinical area ever to be removed from the QOF.

Two clinical areas are now left with only a register and no further indicators. Learning disabilities has lost the TSH in Down’s indicator. This is a good thing as it could be impossible for practices to achieve in many cases. Epilepsy has no indicators at all now with just a single point left for having a register.

It was a close thing for contraceptive indicators. The need to advise a long acting reversible contraceptive (LARC) will now only apply if patients are prescribed an emergency contraceptive (3 points) but the register (4 points) remains.

GPPAQ, erectile dysfunction and dietary review in diabetes and anything other than an annual review in rheumatoid arthritis go as well.

Cholesterol measurement is out, except for patients with diabetes. Hypertension has not only lost the GPPAQ indicators but also the lower blood pressure threshold. There will be twenty points for the upper threshold but this will be a far cry from the sixty points that were previously available for getting blood pressure to target.

This all sounds like less work, but it probably won’t be much different. GPs are not going to stop doing the clinical work, and that NHS England has said that it is not going to stop monitoring these “retired” indicators.

Many managers may be asking – what is happening to the money? For all of the clinical indicators it is going into the global sum. Nationally it will be the same money for roughly the same work.  How your practice will be affected is going to be difficult to work out in advance. In general practices with low prevalence and a higher global sum will do well and vice versa.

The cash from the QP indicators is going to a new Enhanced Service around unplanned admissions. We don’t have the full details of this but it looks to be every bit as onerous as the indicators that it replaces and the cash is likely to be tight to cover all of its requirements.

Undoubtedly there will be fewer points to chase and many of the sillier indicators have been removed. QOF is returning towards its roots. It will be close to the size of the original clinical domain. This is not a panacea for workload issues but after the fairly challenging changes this year should make things just a little easier in the next.