GPC draws battle lines over QOF plans

The GPC has published its formal response to the government's consultation on proposed changes to the QOF in the 2013/14 GP contract, saying the plans will have 'serious implications for patients and practices'.

Dr Laurence Buckman: Plans will have 'serious implications for patients and for GP practices'.
Dr Laurence Buckman: Plans will have 'serious implications for patients and for GP practices'.

GP leaders said the DH's QOF overhaul could cause a 'significant' rise in practice workload, harm practice finances, increase public scrutiny on practices, risk increasing 'potentially dangerous' adverse effects of polypharmacy, and undermine the patient-doctor relationship.

Some changes will have an effect on workload 'so profound that they could skew healthcare towards certain sections of the patient population at the expense of other patients', they said.

The GPC calculates that practices could lose £3,700 from QOF income in 2013/14 due to tougher thresholds alone. Losses could rise to £11,300 by 2014/15, it said.

GPC chairman Dr Laurence Buckman set out the GPC's response in a letter to Richard Armstrong, head of primary medical care at the DH.

He said: 'The proposed changes to the QOF from April 2013 are likely to have serious implications for patients and for GP practices'.

However, the GPC has agreed to a number of the planned changes to QOF indicators.

'No evidence'
Announcing the plans in December, Mr Armstrong had said the changes would 'benefit more patients in receiving evidence-based care that will save more lives and enhance quality of care for people with long-term conditions'.

Since then, the GPC has been vocal in its opposition to the proposals.

Dr Buckman's letter marks the first stage of the BMA's formal response to the GP contract consultation.

Plans to raise QOF thresholds drew the biggest criticism from the GPC. It said the proposals 'would disadvantage practices financially, could put patient care at risk and will reduce patient choice'.

Under the plans, practices would need to achieve the level of the 75th centile of best-performing practices nationally to earn maximum points - steeply raising upper thresholds to as much as 100%.

He added: 'We do not believe there is any evidence to support this and that it could have serious implications on patient care.'

This includes affecting patient access to non-QOF consultations, he said.

But Dr Buckman revealed the GPC had offered the DH an olive branch during negotiations earlier last year. The GPC had been willing to raise existing thresholds by 5% in nine key areas - a deal similar to that since agreed in Nothern Ireland.

Dr Buckman said introducing more aggressive BP targets would require many more appointments for hypertensive patients, displacing patients with other conditions. The plan risks more patients suffering 'the adverse effects of polypharmacy, including potentially dangerous hypotension', as GPs try to hit BP targets of 140/90 mmHg or less, rather than the 150/90 mmHg target at present, he said.

'Significant knock-on effects'
The GPC has previously warned that the lack of available services could push up exception reporting in some areas. In the letter, Dr Buckman explained how this could raise public scrutiny of practices' QOF acheivement. 'The GPC does not want to see practices forced to justify exception reporting rates inflated as a result of these changes,' he said.

But he suggested a compromise, whereby a new code would flag up the lack of service availability in QOF coding. The GPC would also agree to the changes if availability of such services - for instance, pulmonary rehabilitation - could be guaranteed nationwide.

He criticised plans to assess physical activity among patients with hypertension annually, saying this would result in nearly nine million questionnaires carried out across the UK each year. 'This would clearly have significant knock-on effects for the rest of the service arguably with very little discernable benefit,' he said.

The GPC letter also argues that:

  • Plans to lower the age of regular BP checks from 45 to 40 will 'result in a large increase in workload for GP practices' for no extra GP pay, despite DH assurances it was a 'tiny' change. Chasing these targets will affect access for other patients, the letter said.
  • Asking patients with diabetes about erectile dysfunction on an annual basis 'seems unnecessarily insensitive'.
  • Retiring EPILEPSY 8 means many practices may stop doing epilepsy reviews at all for the most complex cases.
  • Shortening the window for annual checks will force practices to conduct all QOF appointments between April and mid-February, affecting patient access.

The GPC has agreed to a number of the proposed indicators, however, including for COPD, depression, diabetes, rheumatoid arthritis and stroke. It also agreed with the principle of the public health domain and, despite past criticism, the continuation of the quality and productivity domain for another year.

The GPC said it had chosen to publish its response to the clinical elements of the GP contract proposals first because the plans are 'complex' and will need to be planned for 'well before April'.

* Minister says GPs will 'rise to challenge' of QOF changes

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