GP improvement held back as CCGs shy away from local QOF reform

General practice is at risk of missing out on the benefits of co-commissioning because of commissioners' nervousness about changing the QOF, a top CCG leader has warned.

Tick box: fears over local QOF reform holding GPs back (Photo: Ian Bottle)
Tick box: fears over local QOF reform holding GPs back (Photo: Ian Bottle)

Aylesbury Vale CCG chairman and NHS Clinical Commissioners board member Dr Graham Jackson said there were barriers in the system to CCGs implementing local changes to the QOF.

Dr Jackson wants to use CCG co-commissioning powers to make local changes to the QOF to give practices ‘headroom’ to learn and develop a more patient-focused approach to managing long-term conditions.

Aylesbury Vale CCG, which has joint commissioning powers, hopes to guarantee practices their 2014/15 QOF income in 2015/16 - in return for ‘leniency’ over the level of QOF reporting, GPs and practice staff will be provided with training in care and support planning to help develop a new approach to managing long-term conditions. 

The CCG will continue to monitor practices' QOF points remotely against last year to ensure there is no drop off in quality.

QOF targets

‘The problems for practices normally is in the last quarter they spend a lot of time chasing the last few points. It's really not very productive from a patient perspective,' said Dr Jackson. ‘We are saying, don't worry about that, you'll get the income, spend that time thinking about change behaviour and delivering things in a better patient-focused way.’

But Dr Jackson, who sits on NHS England’s Commissioning Assembly steering committee,  said there had been some ‘insecurity’ from within NHS England about approving the plans.

‘I use a yacht and supertanker analogy’, he told GPonline. ‘A CCG can think on its feet and move quite quickly, NHS England has layer upon layer which has to understand the changes. Clearly allowing change to happen is quite a threatening situation, particularly if the quality fails then as a CCG we are up for being challenged quite significantly. If it is a co-commissioning arrangement NHS England are with us in that.’

He said there were ‘barriers’ within the system, ‘and people getting worried about what does change mean to the whole system of QOF, and people not quite understanding that we are not throwing this out of the window’.

GP co-commissioning

Dr Jackson added that many CCGs had also so far ‘shied away’ from using their powers to vary and replace the QOF.

‘One of the keystones of co-commissioning was to be able to vary elements of the QOF to [create] headroom. Many CCGs haven't taken that up, but we are trying to find a way of making this work,' he said.

Dr Jackson said there was ‘a risk’ that nervousness within the system could mean the potential benefits of co-commissioning are not realised. ‘However, if projects like ours and others, start to get off the ground and we can disseminate the good practice or change behaviour round the system rapidly and people start to see that people are moving and implementing changes, then I'm hopeful commissioning will reap benefits,' he said.

Dr Jackson said he was now hopeful that his scheme would now be implemented. ‘Practices have bought into this. They are with us all the way. They want to make sure quality is maintained, but also want to find a way to change behaviour,' he said.

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