Square root prevalence factor is ditched

Outcomes payments will be based on true prevalence from 2010, with the square root mechanism being axed next year.

Health minister Ben Bradshaw said the current system was unfair and that the changes would ensure that, by 2010, the money practices received was fairly related to prevalence.

From April 2009, the square root component will be removed and, from 2010, the rest of the controversial prevalence formula abandoned.

A calculation based on a square root was originally introduced to narrow the range of prevalences and damp the effects of pay weighting. Prevalences in the bottom 5 per cent of the range for each disease domain of the quality framework are currently rounded up to 5 per cent to ensure they receive some pay for work done. This adjustment will also be removed.

NHS Employers and the GPC say that these changes will be cash neutral overall, but that 'a small number of practices may experience a significant loss in their current QOF income'.

Primary care organisations will be asked to work with practices likely to be affected, and LMCs to identify whether new services or improvements in care should be commissioned to address these local needs.

Professor Martin Roland, one of the architects of the quality framework said the changes were 'an important advance'. 'This will be widely welcomed. It will be much fairer to GPs.'

Swindon GP Dr Gavin Jamie, a quality framework statistics expert, said the changes would increase the benefits to practices with high morbidity identifying further patients with long-term conditions, but penalise those practices with low morbidity.

'University practices will have lower prevalences of most long-term conditions, so the change is certainly going to hit those practices,' he said.


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