Prevalence adjustments to QOF pay were designed to redistribute funds to support workload in areas with higher disease incidence.
But in 2009/10 the system was skewed so badly that almost all practices in England received identical pay weighting in eight clinical domains including diabetes, mental health, dementia and cardiovascular disease. Pay across all clinical domains was affected to some degree.
Data from the NHS Information Centre show an average-sized practice with high disease prevalence received up to £13,000 less per clinical domain than if raw prevalence weighting had been used, as it will be in 2010/11.
Dr Brian Karet, RCGP diabetes lead, said: ‘It’s clearly not fair: GPs should be aware of this and kick up a fuss when this is happening. The people who are monitoring QOF must iron out errors in remuneration.’
The problem largely stems from a delay between annual data collection dates. Prevalence data is recorded three months after list sizes, allowing prevalence rates to artificially inflate in this time.
Obesity prevalence hit 521% in one practice last year. This anomaly meant that a mechanism meant to protect low-prevalence practices awarded 99% of practices identical pay per point for obesity regardless of actual disease prevalence.
GP revealed earlier this year how growing lists at Darzi centres generated the high prevalence rates. But the full extent of the problem has only now become clear.
Dr Michelle Drage, joint chief executive of Londonwide LMCs, said the phasing out of the square rooting formula that weighted QOF pay until 2008/9 had been ill-timed. Challenges to recoup practice losses remain a possibility, she added.
GPC Wales chairman Dr David Bailey admitted the QOF problems were ‘bizarre’.
Stoke GP Dr Graham Johnston, whose practice has high rate of diabetes, said it was unfair practices such as his received the same pay per point as practices with far lower prevalence.
‘We’d all like QOF to be equitable and reflect the work we put in,’ he said.
Dementia was the worst affected domain last year: 99.7% of all practices fell within the same pay weighting.
From April 2010, raw prevalence will be used and should remove the influence of outliers.