BMA warns Commissioning Outcomes Framework targets raise 'grave ethical concerns'

Commissioning targets raise 'grave ethical concerns' for GPs and risk overwhelming them with excessive bureaucracy, the BMA has warned.

Dr Beth McCarron-Nash: 'Many of the proposed indicators are outside the control of CCGs' (Photograph: JH Lancy)
Dr Beth McCarron-Nash: 'Many of the proposed indicators are outside the control of CCGs' (Photograph: JH Lancy)

Clinical commissioners will be assessed and rewarded using the Commissioning Outcomes Framework (COF).

Responding to a consultation on potential indicators for the framework, the BMA said linking rewards to financial performance could undermine relationships with patients.

‘The BMA has grave ethical concerns about the potential for a reward based on financial performance to damage the doctor-patient relationship,’ it said.

‘A patient should never have reason to think that their doctor is making decisions based on anything other than clinical need.’

The BMA also warned that the indicators were ‘extremely detailed and prescriptive’.

‘We are concerned that such det­ailed indicators may prom­ote and embed a target culture, det­racting from the focus on local healthcare needs and placing a potentially overwhelming bureaucratic burden on clinical commissioning groups (CCGs) and practices,’ it said.

Extremely demanding
GPC negotiator Dr Beth McCarron-Nash said the ind­icators would be ‘extremely demanding’ for practices to monitor and many were inappropriate. ‘Many of the prop­osed indicators are outside the control of CCGs,’ she said.

‘Many relate to provider performance and not commissioning and we are concerned that CCGs could be punished for things they have no control over.’

The use of inappropriate indicators could mean CCGs covering high-need patient populations have resources withdrawn, rather than being given support to commission effectively, she said.

Professor Helen Lester, who leads the piloting of potent­ial QOF indicators, said it was crucial that outcomes targeted by COF indicators could be linked to outcomes over which CCGs had influence.

‘Attribution is as vital for the COF as it is for the QOF,’ she said.

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