Exclusive: Contract talks may halve value of QOF

The proportion of GP income linked to quality targets could be slashed to 10% under plans mooted by health secretary Jeremy Hunt at a private meeting with senior GPs, GP magazine can reveal.

(ISTOCK)
(ISTOCK)

Mr Hunt raised the prospect of QOF cuts at a meeting last month, as negotiators prepared to begin this year’s GP contract talks, a source revealed. 

GP leaders have backed the move to go ahead as early as 2015/16, with a consensus building for further reductions to the QOF after the value of the framework was slashed by a third in 2014/15.

Quality targets

Cutting the QOF to 10% of GP income would roughly halve the proportion of pay derived from quality targets from its current level.

Annual contract talks between the GPC and negotiators representing NHS England are now under way.

The GPC and a source close to the health secretary refused to confirm that QOF reductions were on the table in this year’s contract talks.

However, the health secretary told an audience of GP commissioners earlier this year that after removing 40% of QOF targets in 2014/15, he would ‘like to remove the lot’.

The GPC has urged the government not to ‘throw the baby out with the bathwater’ and has consistently pointed to the valuable part QOF has played in driving up standards across general practice.

Although GPC chairman Dr Chaand Nagpaul refused to discuss the themes of this year’s contract talks, he hinted strongly that the GPC would look favourably on further moves to slash bureaucracy.

‘There is clearly value in patients receiving national evidence-based standards of care,’ said Dr Nagpaul. ‘We would like to promote that while reducing levels of bureaucracy and monitoring, which have become excessive in general practice.’

Given NHS England’s plans to drastically reduce the size of area teams by next April, Dr Nagpaul said health service management may lack the capacity to monitor a QOF system in its current form.

‘We need to move to a way where there is less monitoring, more trust,’ he said. ‘This is the right time to look afresh at ways to ensure national standards without this degree of box-ticking and micromanagement.’

The RCGP too has called for a review to assess whether the QOF can be cut back further.

Manifesto

In a manifesto published ahead of next year’s general election, the college urges the government to ‘review whether further red tape can be cut from the QOF targets where there is not strong clinical evidence for retaining them’.

GPC member and Wessex LMCs chief executive Dr Nigel Watson told GP: ‘When we negotiated it in the beginning, a greater percentage of pay went into the QOF than we thought was right. Reducing that was what we tried to achieve last year and there was a commitment to continue that work.’

He backed the plan to cut quality targets to 10% of GP income ‘as long as the money went into global sum’.

NHS Alliance GMS/PMS contract lead Dr David Jenner also backed the move, and said he believed ‘there is a will’ to reduce QOF further in 2015/16.

Over the medium term, he called for the QOF to be scrapped in its current form and replaced by a series of key performance indicators.

Achievement against these would be ‘less black and white’ than with current QOF targets.

The health secretary revealed last year that after focusing on the frail elderly with care plans and named GP policies in the 2014/15 GP contract, the 2015/16 deal would target support for patients with long-term conditions.

Dr Jenner suggested QOF cuts could fund a contractual requirement for ‘over-75s on four or more medicines’ to have an annual review. He was cautious about the idea of care plans for patients with multiple long-term conditions. Care plans for elderly patients, paid for by axed QOF targets in 2014/15, have proved to be workload intensive for practices.

Dr Watson said care plans ‘could be useful’ for the management of some patients. But he warned that the key factor in helping GPs improve long-term conditions care would be to increase funding.

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