In June, NHS England announced it would allow practices in Somerset to opt out of the national QOF and participate in a local quality scheme pilot instead.
It has now confirmed that further opt-out plans would not be sanctioned, despite interest from several CCGs. This strengthens its stance from January when it suggested further opt-outs would be unlikely.
NHS England board papers released ahead of a meeting on 3 July said it was committed to ‘closely monitoring’ the impact of the Somerset scheme this year and that, should the scheme not produce its intended benefits, the practices must return to the QOF from 2015/16.
NHS Somerset CCG led development of the local scheme with input from the local area team, representing an early example of co-commissioning. Co-commissioning looks set to become more prevalent next year, with nine out of ten CCGs submitting bids for control of GP contracts.
Practices participating in the Somerset Quality Practice Scheme are expected to provide the care incentivised in the QOF and report clinical data, but will not receive funding based on QOF performance.
Funding will instead be used to recognise their contribution to creating more proactive, multidisciplinary and integrated care arrangements across health and care organisations in Somerset.
Important to ensure 'patients don't lose out'
Most practices in Somerset have signed up to the local initiative, but the response in other parts of the country has been less receptive.
GPs at the LMC conference in Liverpool in May said locally-agreed QOF schemes that go beyond the nationally agreed deal risk ‘undermining’ the GPC contract and potentially ‘depriving practices of funding’.
GPC deputy chair Dr Richard Vautrey told GP there were ‘real issues’ with allowing local divergence from the QOF, and said it was the 'right approach' not to expand the pilot to include other areas this year.
He said: ‘We now need to look and see what happens to patient care when QOF indicators are removed and that can help inform future decisions.
‘We have big problems with the scheme about fragmentation and availability of care around the country. It's important we ensure that everyone has same access to a high standard of care wherever they are, and that is what QOF has allowed us to deliver. It’s important that we ensure patients don’t lose out if we change this.’
The success of the pilot will be independently evaluated by the South West Academic Health Science Network, which will assess the impact of the scheme on health outcomes and patient confidence in services.