Final talks on QOF-free Scottish GP contract almost complete

Talks on a new Scottish GP contract that will formalise a system to replace QOF are almost complete, Scotland's deputy chief medical officer has confirmed.

Deputy chief medical officer for Scotland Dr Gregor Smith (Photo: Nick Bostock)
Deputy chief medical officer for Scotland Dr Gregor Smith (Photo: Nick Bostock)

Speaking at the RCGP annual conference in Liverpool on Thursday, deputy chief medical officer and former GP Dr Gregor Smith said negotiations between the BMA and the Scottish government were at a crucial phase and would conclude shortly.

A new deal dubbed the 'Blue Book' will be published in November, with a 'national engagement' process including roadshows led by BMA and government officials leading up to a special conference on the contract in December.

The deal, which will formalise the post-QOF general practice system in Scotland, will take effect from April 2018.

GP clusters

GPs across Scotland have been operating in 'clusters' since 2017, following the decision to abolish QOF from April 2016 - a move that saw all 659 quality points scrapped and moved into core funding.

Dr Smith said that in Scotland, the NHS had 'completely uncoupled' financial incentives with the way that GP practices receive their core funding, moving to a peer review system in which practices within clusters work together to maintain quality and deliver healthcare that fits the needs of their patients.

RCGP president-elect Dr Mayur Lakhani, in the audience, called the peer-based approach 'fantastic' and said he hoped that England could emulate it.

Dr Smith said the decision to remove QOF was justified because 'many of the approaches we would recognise with quality improvement did not exist in QOF', warning that 'lots of unintended consequences' had begun to come through from the framework.

GPonline reported last month on research published in the British Journal of General Practice that found the QOF did not improve the health of patients with long-term conditions, and could have a negative impact on their health.

Carrot and stick

Edinburgh GP and RCGP Scotland quality lead Dr Jenny Bennison told the conference that Scotland had moved on from the QOF era, having realised that an approach involving 'rewards and punishment, carrots and sticks, eventually goes wrong'.

She said the current scheme operating across Scotland, with practices joined up in 148 clusters of around 6-8 practices each, was built on 'reducing mandatory measurement', freeing up time for people to decide what to do; stopping 'complex individual incentives' and shifting the business model of primary care away from revenue towards quality.

Dr Smith told delegates: 'We don’t want to be harassing, scrutinising so people can’t get on with their jobs. We are dealing with professionals here – the idea is to say we trust you as a profession. There has to be a proportionality in terms of assurance – there will be data shared back with the system that provides some assurance to the centre.

'I am aware those discussions are taking place as part of contract negotiations – what are those data sets that are going to be shared to provide that assurance.'

He told GPonline that local primary care organisations could step in if practices across a cluster began to slip outside national quality benchmarks. But he was confident they would not back away from allowing practices to manage their own quality within clusters, because local managers have set strategic commissioning plans that focus on local needs, in agreement with practices.

Full coverage of the RCGP annual conference 2017

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