Exclusive: Local QOF targets offer NHS savings

Introducing quality and productivity (QP) indicators into this year's QOF has allowed GPs to begin redesigns of care pathways that could save the NHS millions, GP leaders believe.

Dr Sarah Jarvis: tests could be carried out in primary care to cut referrals (Photograph: JH Lancy)

GPC deputy chairman Dr Richard Vautrey said dialogue had been opened up by the introduction of indicators for reducing outpatient referrals and emergency admissions into QOF (QP7 and QP10).

'The real benefit in many areas has been the opportunity for GPs to discuss with colleagues about how existing clinical pathways could be changed to improve the way patients are treated,' he said.

GP obtained details from 29 PCTs of the quality and productivity indicators agreed locally for reducing outpatient referrals and emergency admissions in 2011/12.

For the emergency admission indicators, worth 47.5 points, PCTs are most often looking to cut admissions for COPD and cardiology, particularly heart failure and AF.

NICE has estimated that reducing hospital admissions for COPD could save £15 million a year and that cutting hospital admissions for heart failure could save £45 million.

Norfolk GP Dr Daryl Freeman has shown in two local practices that improved COPD management can halve admissions for the condition. Two local commissioning groups have now agreed to roll out similar schemes as part of the quality and productivity indicators, she told GP.

For the outpatient referral indicators, worth 21 points, the most common areas targeted are orthopaedics and gynaecology, particularly menorrhagia and assistive fertility services.

RCGP women's health spokeswoman Dr Sarah Jarvis said many tests and treatments could be carried out in primary care to cut menorrhagia referrals. 'With menorrhagia there are other options. There is an awful lot that can be done in primary care.'

She added that she would be concerned if PCTs were seeking to cut fertility referrals by ignoring NICE criteria for IVF, as some PCTs have previously attempted to do.

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