Officials from the Northern Ireland health department have told GP leaders they will not change the way QOF payments are made to take account of increased list sizes caused by the spate of practice mergers and closures buffeting the service.
Northern Ireland GPC (NIGPC) is now preparing possible advice for practices to cut services to match funding losses. NIGPC is already co-ordinating the collection of undated contract resignations in preparation for practices to leave the NHS in response to the funding, workload and workforce crises.
The latest setback for practices is a result of the QOF payment mechanism, which is based on practice list sizes. Increasing average list sizes means lower payouts for many practices. GP leaders said that around 80% of practices would lose funding because of the anomaly, with around £1m lost from general practice overall.
NHS England has responded to increasing list sizes by increasing the value of QOF points over several years.
NIGPC chair Dr Tom Black said: ‘We have been negotiating with the department on behalf of our members. After many weeks of negotiation the department has decided to pay QOF on the basis of the increased list sizes and as a result 80% of practices will lose funding.
‘There are many practices that will lose more than £20,000 and the total loss to general practice will be £1m. This is not profit for GPs, but money that is reinvested in their practices through employing staff, investing in premises and technology and meeting the financial overheads of running a practice.
‘This reduction in payments is happening because the average list size in Northern Ireland has increased due to collapsing practices and mergers, and given that the practice list size acts as the denominator in the payment calculation it results in a smaller quantum for QOF achievement. There may be other confounding factors related to prevalence and mergers but essentially this is a statistical quirk and the department has decided to take advantage of this by cutting GP funding and saving themselves £1m.
‘The same issue happened in England but their government moved rapidly to cover the gap, so the decision of our department is not only astounding but is a kick in the teeth for GPs in Northern Ireland who are keeping a GP service afloat despite having the smallest workforce and the lowest funding. Funding evidence coming from our accountants indicates that we're being funded at a rate of £101 per patient per year compared to England £142.
‘GPs across Northern Ireland will be rightly furious about this decision and are now being forced to take further action. We will bring a possible action GPs can take to our NIGPC meeting on Wednesday outlining how practices can make cutbacks to their services equivalent to the cuts in funding that they will now suffer.’