Thresholds for many QOF indicators are rising so practices face more work to maintain achievement levels. They will also be expected to deliver on a number of retired QOF indicators (including those relating to prescribing efficiency) for no extra pay.
Because the uplift is being delivered as an increase in the value of QOF points, rather than through core pay, this means that very few practices will be lifted off MPIG next year. Almost a decade on from the original new GMS deal, the majority of practices are still not funded via the Carr-Hill formula that was supposed to make practice payment fairer.
As a result, more GMS practices may be forced to negotiate local deals, such as those in Derbyshire and Liverpool, to help correct historical funding inequalities.
The changes also mean that GPs already overburdened with paperwork have yet more layers of bureaucracy to contend with.
There is concern that the quality and productivity (QP) indicators for reducing A&E attendance could lead to practices being involved in a 'paper chase' with hospitals. And, while most GPs will be pleased that the government has backtracked from complete abolition of practice boundaries (for the time being at least), the plans for practices in England to negotiate an 'outer boundary' to enable greater patient choice will be another administrative headache for GPs.
In the current financial climate it may well be that this is the best deal the profession could hope to receive. But this won't change the fact that most GPs will be heartily sick of being asked to do more for less yet again and the prospect of another year of stagnant income. This will surely have a negative impact on GP morale and, for practices at the lower end of the funding scale, it could even affect their financial viability.