GPs face QOF overhaul as DH reveals changes to contract

GPs will see a massive overhaul of QOF funding from April after the DH's final GP contract deal for 2013/14 rejected most of the GPC's objections to the plans.

The DH has deferred the introduction of four indicators, but most of its plans for the QOF will go ahead despite GPC opposition
The DH has deferred the introduction of four indicators, but most of its plans for the QOF will go ahead despite GPC opposition

The DH has announced the outcome of a consultation on its plans for the 2013/14 GP contract, and has chosen to adopt nearly all the proposals set out in December.

As a result, the huge package of changes to the QOF will now go ahead from 1 April, and may mean practices see large swings in QOF funding as the changes take effect.

The GPC had warned the DH's plans could cause a 'significant' rise in practice workload, harm practice finances and undermine the patient-doctor relationship. Tougher thresholds alone could cost the average practice £11,000 a year from April 2014, the GPC had warned.

Despite concessions by the department over five QOF indicators, the DH has adopted almost all NICE's proposed indicators, as well as far tougher thresholds and the scrapping of the organisational domain, which will be used for four controversial new directed enhanced services (DESs).

The DH will defer two proposed indicators - for referral to cardiac and pulmonary rehabilitation - until April 2014 'to allow more time for GPs to work with clinical commissioning groups to ensure the necessary referral services are in place'.

Many GPC objections rejected
The GPC had warned the services were not available in some parts of the country and so could lead to some practices losing out on income.

The DH also agreed to phase in higher thresholds for two physical activity QOF targets, and to increase the share of QOF points for these and a BP control measure 'to recognise the initial impact of these indicators on practice workload'.

However, many of the GPC's concerns over the plans appear to have been rejected.

These included concerns over unnecessary extra training requirements for diabetes dietary review, questions about erectile dysfunction among patients with diabetes, and the retirement of several indicators including CKD2, EPILEPSY 6 and BP4.

The GPC's objections also included the mass raising of QOF thresholds to force practices to match the 75th percentile of national performance, and the shortening of the time period in which to conduct annual reviews.

Responding to the consultation on the plans in February, GPC chairman Dr Laurence Buckman had said: 'The proposed changes to the QOF from April 2013 are likely to have serious implications for patients and for GP practices.'

The NHS Commissioning Board will now publish more details on the new DESs soon, which will include phasing in the new services.

GP practices will also share £10m a year for two new vaccination programmes for rotavirus and shingles.

* DH reveals full detail of 2013/14 GMS contract deal

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