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Local QOF shake-up risks fragmented national contract

Early exit plans could lead to inconsistent care

Jo Carlowe

Tuesday, 14 January 2014

Locally agreed plans to enable GPs to stop QOF reporting could lead to a fragmented national GP contract.

The warning comes from Dr Richard Vautrey, GPC deputy chair and a GP in Leeds, who says that local arrangements to redesign QOF could lead to inconsistencies in patient care.

Dr Vautrey’s comments come, after an agreement was reached with Devon and Cornwall LMCs, CCGs and area team to implement the contract changes early, with practices focusing on the new enhanced service in return for being paid the 341 QOF points in full that will cease in April.

Somerset CCG and LMC have implemented a similar scheme. On January 10th a letter went out to all Somerset GPs stating that an agreement had been made with the Area Team to ‘switch off the reporting of QOF for the first three months of 2014’.

The letter (published in Pulse) stated: ‘The time freed up can be used to co-design changes in primary care delivery for April 2014 onwards.'

‘Participating practices may now safely stop reporting QOF for this year’ the letter stated in bold capital letters.

Some 70 practices had confirmed their support for the first three months’ work.

In a statement to OnMedica, Dr Vautrey said he could understand why the scheme would appeal but also warned of some dangers.

“Many GPs have questioned the wisdom of chasing QOF points in the next 3 months that will be dropped in April, and the scheme in Devon and Cornwall is an appropriate response to that concern,” he said.

But he added: “The Somerset proposal risks practices left with a much larger locally negotiated contract, which might have some initial attractions, with many practices having lost confidence with the current box ticking approach of QOF, but which over time could develop into something they are less than happy with, as we have seen with many QOF-QP schemes around the country. In an increasingly fragmented NHS we would not want to see a fragmented national GP contract which ultimately will lead to inconsistent care offered to patients in England.”

Aware that some GPs may have concerns over a redesign of QOF, the Somerset letter signed by Dr David Rooke, chair of Somerset CCG, and Dr Sue Roberts, chair of Somerset LMC, stated: “I would…like to emphasise and reassure you that although the CCG and LMC want to seize the opportunity, the project will be approached thoughtfully and with clear planning for an exit strategy that does not disadvantage participating Somerset practices should we need to revert to the National QOF arrangements.”

Dr David Rooke, chair of Somerset CCG, confirmed to OnMedica that a mechanism will be put in place to ensure GPs will not be penalised and said that the scheme, if successful, could be used to help shape future ways of working.

“This is a local pilot - testing out a different way of working…which should inform the next round of the national contract and give strength to the negotiating team.”

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