A GPonline poll of 462 English GPs found that 44% believe the QOF should be scrapped, as it has been in Scotland. Some 32% agreed with NHS England plans to keep the framework, but reduce its scope, while 12% said the QOF should remain as it is and a further 12% said it should be expanded to incentivise a wider range of work.
Earlier this year NHS England’s review of the QOF, which involved NICE, the BMA, the RCGP and other key stakeholders, put forward recommendations on how the QOF should change.
The review suggested that up to a quarter of QOF indicators could be scrapped, many indicators could be updated to improve efficacy, a new domain should be added to promote quality improvement and changes should be made to exception reporting. Some of the changes could take effect from April 2019, depending on GP contract negotiations.
The review also said a 'network-level QOF' could be developed over time. This could mean a share of practice’s funding would be tied to performance across a group covering between 30,000 and 50,000 patients.
Respondents to GPonline’s poll were overwhelmingly against this idea. Only 15% said they welcomed the idea of network-level QOFs, 59% were against the proposal and 26% said they were unsure.
'Tick-box exercise'
Many of the GPs responding to the poll felt that the QOF had become a 'tick-box exercise' that was now outdated.
‘At its introduction it made sense and undoubtedly improved patient care initially. As time went on it's become harder and harder to achieve QOF points and some of the levels set are not sensible for everyday general practice. It's become much less about improving patient care sadly and more of a box-ticking exercise,’ one GP said.
Another added: ‘GPs should have freedom to look after each patient as an individual. QOF has led to the frail elderly coming to harm from polypharmacy.’
‘This is an outdated method of creating work which often makes little sense and has poor links to an evidence base,' said one GP.
However some were more positive. ‘I don't think QOF is a bad thing, it could be better, but it does represent ongoing audits and makes us try and engage with patients who don't come for annual reviews,’ one GP said.
QOF review
The QOF was scrapped in Scotland in April 2016 and funding was transferred to core pay. It had been thought that England might follow suit, but NHS England's recent review has instead put forward suggestions for an 'evolution of QOF' that could 'take a number of years'.
The review said that 'a case could be made for up to a quarter of current indicators' to be dropped from the QOF altogether.
It also said that many QOF indicators could be updated to 'improve efficacy and impact where there is good evidence', potentially through 'a more targeted approach to population segments'. Last week NICE added eight new indicators for diabetes to its QOF menu, which is used during GP contract negotiations to decide what to include in the QOF, which show how this approach could work.
The new diabetes indicators use stratification based around whether or not a patient has moderate or severe frailty to set treatment targets and reduce cardiovascular risk. NICE said the indicators would support 'personalised care' and prevent overtreatment.
