Editorial: Busy practices need fair share of QOF pay

A list of FAQs on the BMA website explains that the QOF is meant to 'resource practices to deliver high quality care to patients by helping them employ the staff they need to offer quality, however many patients there are'.

But GP reports this week that flaws in the system for directing pay to the practices that need it most wiped out prevalence weighting across much of the QOF in 2009/10.

As a result, practices with disease prevalence well above the national average received the same pay per QOF point as practices with almost no prevalence in many disease domains.

The problem has occurred because a mechanism meant to uplift pay for practices with very low prevalence to guarantee them a basic level of QOF income has been distorted by practices reporting abnormally high prevalence. Bizarrely, practice list sizes and disease registers are not counted at the same time for QOF purposes.

Darzi centres with growing patient lists therefore had prevalence rates in some disease areas far in excess of 100 per cent - wiping out prevalence weighting for practices with disease rates in the normal range. In previous years, similar problems have occurred because care homes and a handful of practices that are effectively rooms in hospital wings have been included in the QOF, reporting disease rates above anything a standard practice would have.

Anomalous results like these have made QOF pay weighting unfair for several years.

From 2010/11, pay will be weighted for the first time according to raw prevalence, and the mechanism for supporting low prevalence practices will be removed.

This change will make QOF pay reflect workload more than it currently does. But it's hard to see why the statistical aberrations that have neutered QOF pay weighting year after year have been allowed to continue.

Tackling these may have been a fairer way to improve pay distribution than cutting support for low-prevalence practices, leaving university practices questioning whether they can remain in business.

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