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GPs’ ‘quality premium’ reward may be unachievable

BMA warns patient care will suffer to achieve cash rewards

Adrian O'Dowd

Tuesday, 26 February 2013

GP commissioners will struggle to qualify for the government’s new quality premium payments without sacrificing the quality of patient care, the BMA has warned.

The premium, which is designed to financially reward clinical commissioning groups (CCGs) for achieving set national and local targets, is something that will not be possible without cutting corners and damaging patient care, said the BMA.

This premium will take the form of a pounds-per-patient payment, which has not yet been set, for achieving four national targets in the NHS Outcomes Framework and three local targets.

The four national targets are:

  • reducing potential years lost to preventable deaths
  • reducing avoidable emergency admissions
  • roll-out of the friends and family test, whereby patients would recommend service providers to people who they know
  • preventing healthcare associated infections such as clostridium difficile.

The NHS Commissioning Board draft report Quality Premium: 2013/14 Guidance for CCGs published in December of last year, says that CCGs must not overspend if they are to qualify for quality premium payments and that payments will be cut if CCGs do not honour NHS Constitution rights and pledges.

Fresh doubt over the premium has been voiced by BMA GPs committee chair Dr Laurence Buckman who said GP leaders were strongly encouraging doctors on CCG boards to consider whether it was possible to achieve quality premium payments while remaining professional.

Dr Buckman said it was essential for CCGs to remain on budget if they wanted to see the quality premium paid into their overall budgets.

“The reality is that by setting financial targets that are virtually undeliverable, you either have to cut service to patients in a way that we regard as unprofessional … or you have to say ‘Well, actually, we can’t do this’,” he said.

“We think the CCGs need to look very carefully at whether the quality premium is the right thing to do.”

A spokesperson for the NHS Commissioning Board said: “The quality premium indicators are designed to focus on outcomes spanning the five domains of the NHS Outcomes Framework, and to leave flexibility for CCGs to determine how best to improve these outcomes.

“It has been recognised in healthcare systems around the world for some time that real quality improvement can be achieved with the careful and considerate use of financial incentives.”

Meanwhile, the government is currently considering responses to the GP contract changes consultation.

The GPC submitted its response last week, warning that the proposals put targets before patient care and that they would destabilise GP practices, reduce access for patients and put GPs and staff under more workload strain.

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