Exclusive: QOF delays leave GPs facing losses

Practices are struggling to achieve payments relating to 10% of the QOF, after PCTs missed deadlines for agreeing local targets, GP can reveal.

Dr Deborah Colvin: 'Delays in reaching agreements will make it harder for practices to hit targets' (Photograph: JH Lancy)

A GP investigation found that less than half of PCTs met the 30 June deadline for choosing areas for improved prescribing under the new quality and productivity domain, worth 96.5 points.

Despite prolonged local negotiations, almost all PCTs used the same set of 15 indicators proposed by the National Prescribing Centre (NPC).

96% of PCTs used indicators from this list and only one in three trusts have developed any of their own measures to add to these.

GP used the Freedom of Information Act to request details from PCTs and received responses from 68 trusts.

GP's investigation also found that, in agreements that have been reached, the thresholds practices must achieve vary widely between PCTs.

For one indicator on osteoporosis prescribing, practices reaching the same achievement level would gain five QOF points in one part of the UK but just one point in others.

For other indicators, payment thresholds set by PCTs for the same indicators varied by more than 20%.

GPC deputy chairman Dr Richard Vautrey said it was 'inevitable' that PCTs sought to use 'readily available information' on the NPC's list.

He said the GPC 'recognised the difficulties' practices faced in dealing with delayed agreements, but that local discussion and comparison of prescribing practices should prove useful.

Dr Vautrey also said that the GPC had wanted to reach a national agreement on three indicators, but the DoH had feared pharmaceutical companies could challenge the legality of such a system.

Dr Vautrey said the quality and productivity indicators lay 'outside the NICE process'. These indicators could therefore be retired as part of negotiations for next year's QOF.

Dr Prakash Chandra, chairman of Newham LMC in east London, said the process of developing indicators had not been managed well. 'We were given information quite late and then it has changed, and details come in dribs and drabs,' he said.

'We get one piece of information one day and something else another. There is quite a bit of confusion and we are all struggling. Half of the year has already gone and it hasn't started,' he said.

The 10 most commonly chosen prescribing areas for the QP1 indicator:
1. Hypoglycaemic agents.
2. Lipid-modifying treatments.
3. Proton-pump inhibitors.
4. Non-steroidal anti-inflammatory drugs.
5. Alendronate.
6. Antibiotic prescribing.
7. Renin-angiotensin system drugs.
8. Intermediate and long-acting insulins.
9. Clopidogrel.
10. Blood-glucose strips.

Dr Deborah Colvin, chairwoman of City and Hackney LMC in London, said that delays in reaching agreements will make it harder for practices to hit targets.

She said that, even where areas decided on similar targets, she saw the benefits of practices deciding targets, rather than having them imposed.

'We have been able to negotiate things that are useful to patients, and are about improving patient care, rather than just saving money,' she said.

Dr Paul Roblin, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMCs, reported a 'very mixed picture' regarding local discussions.

PCTs complained that unavailability of historical prescribing data had meant they could not reach agreements before the 30 June deadline.

Dr Chandra said indicators in his area focused solely on cost. 'We are compromising some of the quality of care and not giving patients enough opportunity to digest what we are doing.'

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