NICE’s QOF review committee has proposed that thresholds be matched to practices’ current levels of achievement.
Upper limits could be set at levels achieved by the top quarter or half of practices. Lower limits could be matched to the achievement of the bottom 1% or 5% of practices, the review committee has said.
Wiltshire GP Dr Gavin Jamie, a QOF statistics expert, has calculated that introducing these thresholds would, on average, raise current upper thresholds by around 12-16% and bottom thresholds by somewhere between 12% and 53%.
‘The practical upshot for practices is more work to get the same money, or the same work to get less money,’ Dr Jamie said. ‘No indicator gets easier and many - even at the 50th centile - get much harder.’
NICE recommended that thresholds be reviewed regularly. Raising thresholds would, the review committee suggested, ‘act as an incentive for improved performance’. It pointed out that, at present, achievement rates for all but three indicators were ‘substantially higher’ than the maximum thresholds.
However, the committee decided to leave threshold negotiations to the GPC and NHS Employers to discuss.
GPC deputy chairman Dr Richard Vautrey said it was ‘appropriate’ that final decisions would be left to the negotiators.
But he said the GPC expected to face pressure to raise thresholds. ‘There is pressure every year to change the thresholds,’ he said. ‘We believe the thresholds should stay as they are,’ he added.
Previous experience has shown that changing thresholds has a big impact on practices and patients and simply raises exception reporting rates, he said.
- Read the full version of this story in this week’s GP dated 4 September.