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GMS contract - How QOF changes affect GPs

Dr Jeremy Phipps assesses the new indicators that account for nearly 10 per cent of total QOF points.

Prescribing, outpatients referrals and A&E admissions are covered by 11 new QOF indicators (Photograph: SPL)
Prescribing, outpatients referrals and A&E admissions are covered by 11 new QOF indicators (Photograph: SPL)

Depending on your viewpoint, the quality and productivity indicators are either the most obtuse and opaque part of the new QOF requirements for 2011/12 or the most innovative and exciting.

There are 11 indicators worth 96.5 points, or almost 10 per cent, of the total QOF allocation. They cover three areas: prescribing, outpatient referrals and emergency admissions.

Practices will need to move at a smart pace as the deadline for the first prescribing indicator is 30 June.


Indicators QP1 to QP5

The first indicator involves the practice conducting an internal review of its prescribing and agreeing with its primary care organisation, three areas for improvement in quality or cost effectiveness.

Initially I thought this was an update to requirements under MED6 in the QOF, but the guidance states that these areas should be in addition to MED6 prescribing targets.

Since QP2 also asks the practice to agree three areas for improving prescribing as part of a group of practices within the locality (doing this with practices in your shadow consortium makes sense) there could therefore be a potential nine QOF prescribing targets for a practice: three from QP1, three from QP2 and three from M6D6.

However, for many practices, the internal and external reviews of their prescribing may well overlap some of the same areas for improvement.

For agreeing the targets, the practice will earn 13 points with a further 15 potential points for achievements in the three areas. Achievement will be assessed against targets set by local practices based (in England) on PACT prescribing data.

These targets will comprise a maximum of the 75th percentile of the national level of achievement for the quarter ending 31 December 2011. This means that for the maximum five points, practices must be in the top 25 per cent of achievers nationally for the given target.

The minimum threshold will be set at 20 per cent below the maximum, and practices not achieving this level get nothing. There are graded points awards for practices with a result between these thresholds.

The maximum threshold may be reduced in special circumstances for practices where there are local special needs, for example, a large proportion of patients intolerant of a particular medication.

Indicators QP6 to QP8

There is also graded achievement of points.

Five points are available to practices participating in an internal review of outpatient referrals, and a further five points for the comparison and discussion of referrals with at least six other practices in the locality.

Following the internal reviews the practice should compile a report on the categories of its outpatient referrals and of emergency admissions. To achieve the points in these areas, the report should be made available to the participating local practices presumably as the basis of the external reviews.

The final 11 points are awarded to practices that have agreed to the development of three new pathways of referral management and show that they have followed these except when clinically inappropriate to do so.

The pathways should if possible concentrate on chronic conditions and have the expressed aim of reducing referrals.

It does not seem that the three pathways must be the same for all practices in the locality for either this part or the reducing emergency admissions section, but presumably it will be easier administratively if they are the same.

Indicators QP9 to QP11
Graded requirements apply to this area too and the maximum 47.5 points is worth well over £6,000 to the average practice.

This emphasises the importance the NHS is putting on reducing the number and cost of emergency admissions.

The requirements include an initial internal review of the practice's emergency admissions, which is worth five points, with a further 15 points for a review with local practices.

The remaining 27.5 points are for developing three areas of admission avoidance and producing a report at the end of the year demonstrating a high level of compliance with them by the practice.

One of the main issues for GPs will be the quality of the data. Fortunately prescribing data is usually reliable but my experience of data fed back from secondary care, particularly on admissions, is that there are a large number of inaccuracies.

With outpatient referrals potentially practices have little influence with specialties for which external referrals management programmes are already in place.

How the impact of A&E, out-of-hours and walk-in centres on emergency admissions will be assessed is unclear. It seems unlikely that these providers will be able to follow all the admission avoidance procedures of local practices, and consequently the potential financial gain from these schemes may be limited.

There is little doubt that the new quality and productivity indicators are part of NHS cost cuts drive. How successful adapting the QoF will be in helping to reduce costs is difficult to predict.

  • Dr Phipps is a GP in Lincolnshire
  • www.nhsemployers.org for Quality and Outcomes Framework guidance 2011/12

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Ask all practice team members involved in QOF work to read the detailed guidance about the quality and productivity points.
  • Hold a meeting with these team members to discuss the challenges this new area represents and to suggest how best to tackle them. Circulate a report of the meeting.
  • Once you have agreed the aspects on which you need to work jointly with GP reps from local practices, stay in close contact to monitor progress and to iron out problems with them.

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