Proposals from the institute’s QOF advisory committee, which would affect £23,000 of income per average practice, are the clearest sign yet that ministers will seek significantly to reduce QOF’s footprint in the next GP contract.
The review followed a request from NHS England for NICE to investigate shrinking QOF to focus on interventions ‘of the greatest value’.
Health secretary Jeremy Hunt has pledged to cut QOF ‘box-ticking’ and workload pressure.
But GPs fear they will be forced to continue providing services after funding is withdrawn and that attempts to earn back the lost income will drive up workload.
Minutes from a NICE meeting reveal that advisers have identified indicators worth 146 points (£22,910 to the average practice) as ‘less important’ to retain.
Removing these would release £174m of funding across England, but it is unclear if this would be reinvested in general practice.
The advisers suggested that several areas of care currently provided through QOF should instead be incentivised at CCG level. A further £50m of indicators will be kept under review and could be scrapped at a later date.
But removing some ‘less important’ targets may not reduce workload, the advisers admitted. It raises fears of a repeat of the 2013/14 contract, which forced GPs to earn back £120m cut from the organisational domain by providing directed enhanced services – although
the organisational work still had to be done.
QOF expert and Wiltshire GP Dr Gavin Jamie welcomed the review, but said withdrawing cash without removing work is ‘not a solution’ to workload pressures. ‘It does not make practices more able to deliver care. It reduces the resources available.’
The loss of funding could be ‘particularly dangerous’ for additional services such as cervical screening and contraception, both flagged for removal, he said. In 2004, cash for these services was divided between QOF and the global sum.
‘Cutting these indicators will not reduce the burden on practices a great deal,’ Dr Jamie said. ‘GMS practices are within their rights to stop doing these and may well do so if these services become unviable.
‘They will lose a small amount of their global sum, but cutting loss-making activities could be what practices need to do to survive. It is going to take more than this to change the QOF burden for practices.’
If adopted, NICE’s sweeping review would have a substantial impact on GPs’ work. NICE’s advisers said 22 indicators were ‘less important to retain’ – in effect giving the green light to removal.
This means that of the 900 points in QOF, indicators worth 146 points would be withdrawn, while a further 42 points would be under review.
Indicator timeframes would return to 15 months to ease workload pressures around March. This and other proposed wording changes would affect 414 points. Just 298 points would be unaltered if the proposals were adopted in full.
Indicators likely to be withdrawn include the much-maligned General Practice Physical Activity Questionnaire targets. However, the advisers chose to retain all indicators in AF, asthma, CHD, COPD, dementia, heart failure, hyperthyroidism, peripheral artery disease, and stroke and TIA.
GPC deputy chairman Dr Richard Vautrey declined to discuss plans for QOF while negotiations continue. But he said GPs ‘should be aware that removing indicators does not necessarily mean the work will stop’.
NICE’s review, the most comprehensive reassessment of QOF in years, suggests the DH was wrong to cut indicator timeframes from 15 to 12 months in April. Advisers said the change, enforced by the DH after talks collapsed last autumn, had ‘increased workload’ without ‘any change in the quality of care’. There was ‘much to be gained and little to be lost’ by reverting to the 15-month timeframe, they advised.
NICE also advised that some targets imposed by the DH, and criticised by the GPC, could be removed with ‘little impact’ on care.