Speaking at a Westminster Health Forum event on Thursday, NHS England leaders said CCGs should ‘take on the entirety of commissioning for their locality’, arguing that the current commissioning split had created ‘artificial barriers’ between services.
They recommended moving away from national frameworks and more towards systems that allow for greater local freedom, built around the needs of patients.
Deputy medical director for NHS England Dr Mike Bewick said the QOF was ‘becoming bad for health’, and that it was more focused on creating ‘indicators for incentives’ than improving patient care.
Speaking at the event, he said: ‘I think QOF is becoming bad for health. I think it has now come to the point where QOF is looking at how we use indicators for incentives, whereas we should be using indicators for improving care because people actually look at what they're doing in a way that makes them audited in a professional way.
‘I think QOF is probably here to stay, but we should be developing indicators that are not always linked to incentives, but to how we enhance professionals working together with the end view to deliver better care.’
NHS England primary care commissioning lead Dr Geddes said it was time to move ‘away from processed commissioning towards outcome commissioning’.
He said: ‘What we need to be looking at is moving away from paying GPs for QOF points at the tick of a box and instead saying as a GP you get paid for working with the acute trust or mental health trust to get paid for outcomes.
Focus QOF on outcomes
‘So it’s focusing on the outcomes so that both GPs and the other services all get rewarded – make sure everyone gets rewarded for working together, it creates the interdependence that we need between the services.’
Dr Geddes added that it was time to reconsider how national strategies are implemented. He said it would be better to produce national guidance that local CCG commissioners could then interpret differently, as befits the population in their area.
‘We need to shift our mindset from organisational to being more of a system around the patient,’ he said.
‘We need to look at dissolving traditional barriers that exist. We also need to think about more local whole design of care – this is not about NHS England saying "this is the model of care that will work for everybody" - we know it won't.
‘NHS England is not going to give all answers, because what’s required for the patients in the population in one area will be different from another – there’ll be lots of commonality, lots of systems that will be the same – but there will be a different emphasis in some areas compared to others.
‘This is why co-commissioning is going to be critical at being able to develop with local authorities, with providers, a new way of delivering that. This is about developing a paradigm shift for primary care, which is incremental for the development of the NHS.’