Editorial: Show us the evidence backing local QOFs

GP first reported on the possibility of a local quality framework (QOF) 18 months ago.

The idea received backing from the Health Select Committee, National Primary Care Research and Development Centre (NPCRDC) and National Audit Office before cropping up in the 'NHS Next Stage Review: Our vision for primary and community care' newsletter this month.

It suggests 'allowing a greater local choice of indicators that are sensitive to local health needs and priorities'.

It is an idea that sits well with politicians devolving central control from Whitehall, or other UK seats of government, to where it is delivered. However, clinicians are divided on this issue and much debate is needed before any QOF change from April 2009.

The GPC argues that moving from a UK-wide QOF to a local version will create a postcode lottery, while Dr Colin Waine, chairman of the National Obesity Forum, tells this week's GP that a local QOF could help tackle obesity in areas of high prevalence. When the new GMS contract was implemented in 2004, local enhanced services (LESs) were created to allow primary care organisations (PCOs) the ability to tackle local problems over and above the UK deal.

In any consultation on change PCOs or their representatives must explain why LESs have not been successful, if local QOFs are to be introduced.

If it is because of a lack of money at PCO-level, is this a good enough reason to seek a share of the UK funds bound up in the quality framework?

GPs, generally, have been supportive of the UK deal because it allows standards to be measured across England, Scotland, Northern Ireland and Wales.

A UK deal also gives practices a security that a local QOF, or QOFs, would destroy.

Would it be easier for PCOs to bully practices working to local QOFs?

The mooted involvement of NICE in the QOF redesign should increase the transparency with which decisions are made.

Perhaps, local QOFs would herald the introduction of evidence-based postcode lotteries? Is this to be welcomed or opposed? Practices should make their views known during this autumn's consultation.

So, while the idea of a local QOF is worthy of further consideration, we would urge the DoH not to rush headlong into it as it has done with polyclinics working to APMS contracts. The NPCRDC is calling for any local variations in the QOF to be based on work that has been piloted nationally.

That sounds like a sensible place to start. Let's see the evidence backing local QOFs before making radical change to a system that has worked well thus far.

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