DH proposals for the QOF 2013/14 would set thresholds for achieving maximum points at the level of the best-performing 25% of practices.
A DH model of the proposed changes shows some clinical areas' upper thresholds would rise to 100% - meaning practices would need to treat or refer every single patient with the condition to earn all QOF points in that area. It may force practices to exception report more patients.
In a letter spelling out the proposals, Richard Armstrong, DH deputy head of primary medical care, said the changes would 'benefit more patients in receiving evidence-based care that will save more lives and enhance quality of care for people with long-term conditions'.
GPC negotiator Dr Chaand Nagpaul said the DH had taken a 'hugely crude and simplistic view' of QOF that failed to account for differences in practice populations, local services and infrastructure, all of which can affect achievement.
'There is already a high level of achievement,' he said. 'What will happen is this will simply increase the threshold requirement year on year. This moving, harder target really seems to penalise GPs rather than rewarding them.'
He warned that some practices will simply be unable to achieve these higher targets. 'Practices will lose money because they are not able to achieve the maximum as they would have done in previous years,' he said. 'In some indicators which are low-value, practices will have to consider whether it is worth the effort to work towards lower-funded QOF points.'
Under the proposals, 20 indicators' thresholds would initially be changed to this new approach in 2013/14, followed by the remaining indicators in 2014/15. Only indicators older than three years would be included, as the calculation for quartile performance will be based on data from two years prior.
The proposals would force practices to vaccinate every patient with CHD against flu to earn maximum points. In some areas thresholds would rise by as much as 25 percentage points.