In August 2014 the BMA agreed a period of contractual stability with the Scottish Government until 1 April 2017 but with the proviso that changes judged to be beneficial would be open to negotiation.
Whilst we were keen to retain stability, GPC Scotland felt that the dismantling of QOF would be an important step towards freeing up practice staff time. As GPs ourselves, we know the administrative burden that QOF puts on practices and we understand the need for immediate measures to try and relieve the workload pressures that are currently putting general practice in Scotland under severe strain.
Last year, when we undertook a series of GP roadshows across the country, the removal of QOF was one of the measures that our members asked for, because, like us, they believed that it would help free up time and reduce bureaucracy.
Following negotiation between the BMA and Scottish Government, agreement was reached on changes for introduction from 1 April 2016. This includes the removal of QOF, the creation of GP clusters and the beginnings of new arrangements for quality.
The key changes for 2016-17 are:
- The dismantling of QOF from 1 April 2016 - the remaining 659 points will be retired and the funding will be transferred to practice core funding. The clinical core standard payment and organisational core standard payment will be combined with this new transfer to form a single ‘core standard payment’.
- Practices are not required to continue the administration of the QOF.
- GPs and practice staff will be expected to provide all of the elements of care and clinical coding that the practice considers clinically appropriate.
- QOF data will no longer be extracted for payment purposes but it will continue to be available to practices for their own internal processes including review within their cluster.
- £20m of the funding transferred to core pay (approximately 25% of the amount being transferred) will be designated ‘continuous quality improvement’ funding to support key elements of a transitional quality arrangement (TQA) for 2016/17. Practices will receive this in their global sum.
- Practices will still be required to maintain disease registers and code patients based on diagnosis.
From 2017 onwards it is expected that GP practices and GP clusters will have oversight and direct involvement in improving the quality of all health and social care services provided to patients registered within their locality, including the current chronic disease management programme and use of secondary care services. The 2016/17 agreement introduces changes that start this process.
Arrangements for quality under the contract will be based on professionalism and require GP practices to undertake that work in a cluster basis; a locally agreed grouping of practices. These clusters will need to be formed during 2016/17.
Each GP practice will nominate a GP as a practice quality lead (PQL), and each cluster will nominate a cluster quality lead (CQL). CQL activity (and some PQL activity if it is over and above what is set out in the contract) will be funded from outside of the GMS contract.
What do practices have to do?
Every GP and other staff in the practice will be expected to consider data provided to the PQL and reflect on that data, as well as a view on what future data might be required to support quality in the practice.
The PQL will also be expected to share the data provided via the CQL with relevant members of the practice and to collate a practice response to it. They should also form a view, on behalf of the practice, of the data required to support the future quality activities of the practice and its cluster. The capacity to undertake this activity will come from the dismantling of QOF and is expected to require approximately two hours per month.
Each GP practice will develop a process for ensuring that GPs and relevant others in the practice can be fully involved in quality work, such as reflection on materials and discussion on a practice level response to the CQL.
GP clusters will reflect upon the individual practice access reports provided by local GP practices over the past two years (alongside any board-wide or national learning from aggregated reports that might add value) to consider what could be done to further improve access arrangements locally. This could include sharing of local and national good practice; and how other health professionals should respond to patient demand.
We believe that the changes implemented in April this year will go some way to reducing bureaucracy in practices and prepare the way for a more professional contract. GP clusters are an important development because they allow peer review of practice quality.
Quality will be a key focus of clusters, through peer review of practices, and reviewing the quality of services provided locally through the HSCP. As they develop we expect clusters will have growing influence over how services are delivered in the community by HSCP for their patients.
Whilst we hope that you will notice a positive impact from these changes, we know that more needs to be done, which is why the BMA is currently negotiating with the Scottish Government to agree a new GP contract for Scotland.
- Dr McDevitt is chair of the BMA’s Scottish GP Committee