Report casts doubts over fairness of QOF pay

PCTs' poor management of exception reporting in QOF means payments may not be fair or accurate, an Audit Commission report claims.

Andy McKeon: 'Audit isn’t just about counting the pennies, it’s about ensuring that patients get the services they are entitled to.'
Andy McKeon: 'Audit isn’t just about counting the pennies, it’s about ensuring that patients get the services they are entitled to.'

The report found large variations in how well PCTs managed performance checks for exception reporting and payment for GPs’ work in QOF.

It suggested some trusts ‘cannot be confident that payments made to GP practices are correct and justified, or delivering good value’.

Andy McKeon, managing director of health at the Audit Commission, said: ‘Audit isn’t just about counting the pennies, it’s about ensuring that patients get the services they are entitled to and that taxpayers’ money is spent in the best possible way.

‘Our report shows a wide variation in how PCTs approach this, ranging from poor to good. The best can be confident that they are spending the money well, GPs are getting the rewards they deserve and patients are getting the services they need.

‘But in some areas that isn’t the case and patients may be missing out because of poor administration of the scheme.’

The Audit Commission collated the findings of external auditors who had carried out work at 12 PCTs. It assessed PCTs' management of QOF payments relating to exception reporting, arrangements for conducting visits to practices by PCTs, and action taken.

It found large variations in levels of exception reporting between practices in each PCT, although it conceded this may be due to geography or deprivation.

It questioned whether PCT's practice visits, made to assess practice performance in QOF, were made simply to improve QOF scores with no real benefit to patients.

They added that ‘most PCTs found it difficult to prove a link between high QOF scores and improved outcomes for patients’.

Additionally, they accused some GP clinical assessors as not remaining independent: ‘Lack of independence sometimes added to lack of clarity about the scope and purpose of QOF visits.

It continued: ‘Most PCTs use GPs from within their own area as clinical assessors and, while this is understandable and practical, especially in less urban areas, it may not result in a rigorous regime.’

Some PCTs admitted they did little to benchmark practices to identify outliers in QOF performance.

The Audit concluded: ‘Greater consistency of approach would provide better assurance that QOF payments were being properly made. It could also bring benefits for patients.’

Mr McKeon said: ‘PCTs will soon give way to the new NHS Commissioning Board and GP consortia. Robust audit will be crucial to ensure the payments are being properly and fairly made under any incentive schemes and patients get the benefits intended.’

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