GPs face tougher QOF in new contract

GPs must achieve higher standards to earn the same QOF points after negotiators agreed to raise the thresholds for performance in the 2012/13 GP contract, published Wednesday.

A new clinical area has been introduced for osteoporosis (Photograph: PROF. P. MOTTA/DEPT. OF ANATOMY/UNIVERSITY)

Negotiators have also agreed to scrap all prescribing indicatrors in the quality and productivity (QP) domain in QOF, introduced in 2011/12.

But the BMA and NHS Employers revealed that practices would be expected to continue doing much of this prescribing work for no extra pay.

Under the changes for 2012/13, all lower thresholds for QOF indicators that are currently 40% will be raised to 50%, while any indicator with an upper threshold of 70-85% will now have a lower threshold of 45%.

There have been further, specific upper threshold changes for 14 indicators.

The changes agreed in the 2012/13 contract mean GPs will need to perform better to earn the same points as in previous years.

Five of the 11 quality and productivity (QP) indicators introduced in the 2011/12 contract have been scrapped.

Negotiators agreed to withdraw QP1-5, which incentivise improvements in prescribing behaviour.

Instead, new QP indicators worth 31 points will see practices work in groups to reduce avoidable A&E attendances.

They will review patterns in use and design a strategy to improve the quality and accessibility of the care provided to avoid unnecessary attendances.

The DoH said the scheme will focus 'in particular on quality of care for older patients with complex health needs at high risk of admission, children with minor illness or injury and patients who frequently re-attend A&E'.

Existing QP indicators covering emergency admissions and outpatient referrals will continue until the end of March 2013.

However, a letter to GPs from the BMA revealed that practices will be expected to continue working to improve prescribing efficiency for no extra pay.

A joint statement from the BMA and NHS Employers said: 'Although the prescribing element of the quality and productivity scheme will be replaced with A&E attendances in 2012/13, we agree that all practices in the UK should continue to ensure cost effective prescribing when compared to peers, building on the progress achieved in 2011/12.

'Those practices who remain significant outliers would also be expected to continue to participate in external peer review during 2012/13.'

Other changes to the contract include the retirement of seven indicators for CHD and AF.

Eight replacement indicators were agreed for diabetes, mental health, asthma, depression, AF and smoking. These will replace seven existing indicators.

A further nine brand new indicators have been introduced. These cover existing domains of AF and smoking, as well as new clinical areas of peripheral artery disease (PAD) and osteoporosis.

Three new organisational indicators will support the remaining quality and productivity domain, including the new points for reducing A&E attendances.

The changes will affect all four countries in the UK.

The value of a QOF point will also rise to fund the 0.5% uplift in the contract.

Summary of QOF changes

Out with the old

  • Retired indicators: CHD13, AF4, QP1, QP2, QP3, QP4, QP5
  • Reductions in points of ‘a number’ of existing indicators worth 26 points
  • Seven indicators replaced with eight recommended by NICE across six clinical areas: diabetes, mental health, asthma, depression, AF and Smoking

In with the new

  • New clinical indicators for AF, smoking, PAD and osteoporosis
  • Three new QP indicators focusing on A&E attendances

Threshold changes

  • All lower thresholds for indicators currently 40-90% raised to 50-90%
  • All lower thresholds for indicators currently with an upper threshold between 70-85% raised to 45%
  • Upper threshold changes for indicators CHD6, CHD10, PP1, PP2, HF4, STROKE6, STROKE8, DM17, DM31 COPD10, and CKD5
  • Lower and upper threshold changes for BP5, MH10 and DEM2

Click here to see the NHS Employers summary of the changes


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