A QOF review published during NHS England's board meeting on Wednesday sets out plans for five main changes to the framework, in what could prove the most significant change since it began in 2004.
Changes proposed in the review - which could take effect from 2019 - reflect predictions from RCGP vice chair Professor Martin Marshall, reported in May by GPonline. Professor Marshall said QOF could become a 'much smaller, more focused set of indicators', with funding shifting to incentivise practices manage 'complex activities through quality improvement programmes'.
Under the review proposals around half of QOF indicators could be updated to 'improve efficacy and impact where there is good evidence', potentially through 'a more targeted approach to population segments'.
The exception reporting process will be 'updated and rebranded' as the 'personalised care adjustment' for indicators. NHS England says 'this would operate at the individual indicator level rather than the domain level, which would bring it into closer alignment with the way in which clinical decisions are taken and patient choice is expressed'.
Changes to exception reporting would aim to boost data quality and 'reduce scepticism around the use of the mechanism', the review says.
A new domain would be added to the QOF to promote 'quality improvement'. This would enforce 'quality improvement cycles to address around three priority areas each year', and would absorb points from scrapped indicators.
The review says that 'a case could be made for up to a quarter of current indicators' to be dropped from the QOF altogether, and that decisions will be based on assessments of the existing targets.
Finally a 'network-level QOF' could be developed over time, with a trial version to be piloted at 'a select number of sites'.
NHS England says the changes could take 'a number of years to phase in', and the changes are subject to contract negotiations with the GPC.
However, NHS England's board was told on Wednesday: 'There was consensus amongst the advisory groups that this was the likely direction of travel, and well aligned with current strategic priorities. NHS England and the GPC will remain mindful of the workload implications and the views of GPs.'
GPC chair Dr Richard Vautrey said: 'We have been pleased to work with NHS England and other partners, to review QOF and produce a report that will stimulate further discussion, given the BMA has been calling for a review of QOF that both provides stability for practices and better enables them to respond to the needs of their patients.'
NHS England's national director, strategy and innovation, Ian Dodge said: '2019 starts the most substantial discussion of the GP contract since 2004 - given the forthcoming long-term NHS plan, current pressures on general practice, the emergence of primary care networks, QOF and indemnity reform, the partnership and premises reviews.
'This calls for more intensive joint working between NHS England and our partners, particularly the BMA, and I look forward to constructive and fruitful discussions.'
NHS England is inviting comments on the QOF review plans until 31 August.