QOF set for 'biggest ever change' in DH overhaul

The QOF faces its 'biggest ever change' from April 2013, with practices forced to compete for points, a whole domain axed and new DESs introduced under plans set out by the DH.

The DH wants QOF's organisational targets axed and the money for these paid moved to enhanced services for long-term conditions, dementia and online access to patient records.

Under the offer made to the BMA, the overall size of QOF would fall to around 845 points and upper thresholds would become harder to hit.

The changes form part of the biggest proposed overhaul since the QOF's introduction in 2004. Other changes proposed include:

GPC chairman Dr Laurence Buckman said the proposal was in effect 'the addition of new work into existing remaining points for no new money'.

'Money taken off QOF will be used to support enhanced services, the details of which we do not know,' he said. 'None of these have been negotiated, two we had never heard about at all.'

Dr Buckman said as far as he knew none of these enhanced services were developed by experts at NICE.

DH proposes major rethink of QOF
The proposals are part of the offer to the BMA unveiled on Tuesday after negotiations between the two broke down following five months of negotiations.

Changes to the QOF form the main plank of the government's plan for the GMS contract in 2013/14. The BMA has rejected the overall proposal as a 'threatened imposition', but may be forced to accept the changes if a settlement cannot be agreed within 13 weeks.

A letter sent to PCT and SHA chief executives on Tuesday and seen by GP spells out the DH's intentions.

All changes advised by NICE in August would be accepted, including retirements, new indicators and changes to wording.

Indicators worth 135 points for depression, diabetes, hypertension, epilepsy and dementia would be retired. In their place would come different indicators for cancer, COPD, depression, diabetes, hypertension and RA.

The whole organisational domain minus the quality and productivity (QP) indicators would be scrapped, a total of 154.5 points.

The DH says these indicators 'reflect basic standards of good organisational practice that should not need financial incentives'.

DH 'aware of workload concerns'
The money from these points would pay partly for the NICE-recommended additions to the clinical domain but also for the new enhanced services to 'support quality improvement and promote innovation'.

The DH told PCT chiefs it was 'aware of concerns about practice workload'.

But it said the new enhanced services would be designed to support general practice 'to make most effective and efficient use of resources to improve quality of care'.

Areas could include diagnosis and care for people with dementia, care for frail or seriously ill patients, enabling patients to have on-line access to services, and helping people with long term conditions monitor their health.

It hinted that GPs would be expected to work with nearby practices on these areas to make improvements and 'to help improve overall use of NHS resources'.

Though the letter relates to GMS contracts, the DH expects the NHS Commissioning Board to pursue a similar deal with PMS contracts.

The DH said GPs' current QOF indicator thresholds were below their average achievement levels. 'Independent research' has shown introducing the QOF cut mortality by 11 per 100,000 people, but that raising thresholds could increase this to 56 per 100,000, the DH said.

In response, it wants to raise upper thresholds over the next two years 'so they are in line with the upper quartile of current performance and maintain that link in setting future thresholds'.

This would effectively mean practices would compete against each other to achieve scores within the top quarter of performance from the previous year. For many practices this would make it far more difficult to achieve maximum points than at present.

It also wants to retain the QP indicators in 2013/14.

The wording of some indicators and related business rules will be changed to avoid 'the unintended anomaly of some practices being rewarded for two years for interventions only carried out (or offered) in one'.

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