Viewpoint: Why NICE's QOF proposals fall short

NICE has made a bold attempt to overhaul the QOF but the result will not be enough to reduce the burden on practices, argues Wiltshire GP Dr Gavin Jamie.

Dr Jamie: 'Ultimately it is going to take much more than this to really change the QOF burden for practices.'
Dr Jamie: 'Ultimately it is going to take much more than this to really change the QOF burden for practices.'

It is fantastic that the whole of the QOF can be reviewed in a public way. It is particularly pleasing that the [NICE QOF advisory] committee can look at many of the indicators that were originally suggested by its previous meetings.

However, removing cash without removing the work is really no solution to anything.

It does not reduce the pressure on practices; it does not make practices any more able to deliver care. In fact, it reduces the resources available to practices. It might make some areas simply unviable for practices.

This could be particularly dangerous in the so-called 'additional services'.

At the time of the new GMS contract a decade ago, the cash for these services, particularly cervical screening and contraception, was split between the global sum and the QOF.

GMS practices are completely within their rights to stop doing these and they may well do so if these services become unviable. They will lose a small amount of their global sum but cutting loss-making activities could be simply what practices need to do to survive.

Cutting these indicators will not reduce the burden on practices a great deal.

It seems likely that not all of the proposed removals will happen. The government has been reluctant in the past to remove the depression indicators when removal was previously suggested by NICE (interestingly in the same year NICE suggested the removal of the thyroid indicators).

Ultimately it is going to take much more than this to really change the QOF burden for practices. This is a good attempt to try to look at the QOF, but it is not at all clear if it will make any impact on the negotiations between NHS Employers and the GPC.

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