During a webinar this week the CQC explained that QOF data - collected by the CQC since 2012 - was no longer a ‘reliable’ indicator for practice performance as data had been 'skewed' by the pandemic.
It said that CQC inspectors would now use ‘additional searches’ from 1 October to assess practice performance, including:
- patients with CKD 4 or 5 and no BP in 18 months;
- patients with CKD 4 or 5 and no U&E in 18 months;
- patients with diabetic retinopathy with last HbA1c>74;
- asthmatic patients with two or more courses of rescue steroids in last 18 months;
- patients on levothyroxine in the last six months with no TSH in the last 18 months.
The move comes after QOF was suspended throughout 2020/21, with income from the framework protected, to allow practices to concentrate on dealing with the pandemic and then delivering the COVID-19 vaccination programme. The BMA has called for suspension of QOF to be repeated this year, but NHS England has so far said it is not considering another suspension.
The CQC also announced that it would no longer be 'rating in terms of population groups', taking the effective key question and the responsive key question - two of the 'five key questions' it asks - as a whole.
QOF data had previously been used by the regulator to see how a practice is performing, but CQC representatives said that this data was no longer ‘reliable’ following the pandemic.
Speaking at the webinar, CQC interim head of inspection for primary medical services Andy Brand said: ‘We are going to stop using QOF data from 1 October and the reason is that it’s been skewed by the pandemic - and we’re going to cease using it for at least 12 months and then review what we do with it after that.
‘We used QOF because it was the best information we had at the time to gain a sense of how practices were performing, and also to see if they were using QOF as a tool to drive improvement. We’re not going to be using that anymore because it’s not reliable.
‘We are replacing QOF in terms of long-term conditions with some additional searches, which will be run by our clinicians on practice clinical systems - from a distance - with their permission. We feel like this is better because the data is up to date as opposed to QOF, which is many months out of date.’
Under a new approach to monitoring services, the CQC is carrying out monthly ‘information reviews’ of practices - looking at data, such as current CQC rating, breaches, safeguarding concerns and patients' experiences, to assess practices.
If the regulator finds no reason to investigate further, practices will be issued with a short statement following the CQC's review. But practices will be subject to further monitoring if inspectors' initial investigations show a need to have 'a deeper look' - and could involve a telephone call with the provider to mitigate risks.
GP practice assessments
CQC leaders argue the new approach is ‘far more targeted and risked-based’ than its previous inspection model, which saw GP practices assessed on a frequency-based model - this approach has now been scrapped.
Earlier this month the regulator said it would increase its use of video calls to interview practice staff during inspections under a revamped approach to regulation that will also reduce checks on surgeries rated 'good' or 'outstanding'.
RCGP chair Professor Martin Marshall last week called for the government to help to reduce GP workloads by cutting unnecessary bureaucracy, suggesting that CQC checks could be scrapped.