Clinical commissioning groups have queued up to follow Somerset’s lead and break away from the national quality and outcomes framework, despite a strong signal from NHS England that further extension of the freedoms were unlikely in 2014-15.

As revealed by HSJ last week, NHS England approved a local alternative to the framework for practices in Somerset.

However, the body has said the freedoms will not be replicated in any other part of the country during this year.

Thanet CCG in Kent approached its local area teams earlier this year to discuss the possibility of developing a local alternative to QOF for their practices, but it was rejected.

Thanet’s accountable officer Hazel Carpenter told HSJ they were still keen to move away from QOF to allow practices more freedom in how they focus on health inequalities, and it was disappointing that would be blocked this year.

She said local member practices were keen to do things differently and felt QOF did not fit the local environment.

“If the CCG membership is to move away from QOF, we will continue to discuss this with NHS England. If it is the right thing to do for us, but  isn’t made possible in the short term , we will ensure we continue to develop the business case so we can take the opportunity when the circumstances change.”

Ms Carpenter said being able to control and localise QOF would be a “significant opportunity in terms of co-commissioning”.

Mark Hayes, chief clinical officer at the Vale of York CCG, said his organisation was also interested in more freedom from QOF.

He said NHS England was being “narrow” in only allowing Somerset the freedoms during 2014-15 when it was still early in the year.

“You want to reduce bureaucracy and you want to stimulate or incentivise behaviours that are aligned to your strategic plan,” Mr Hayes added.

“So for us, our strategic plan is moving towards moving towards a care hub… If we could motivate practices by linking activities aligned to that with the QOF payment, that would be helpful.

“We suspect that if people made a fuss about that and put together a good position, then they probably would go with it, I would have thought. Simon Stevens seems to see it that way.”

The move has been described as a “significant departure” for NHS England, which has previously insisted on a single operating model for all the organisations it commissions.

Linda Prosser, NHS England’s director of primary care in Bristol, North Somerset, Somerset and South Gloucestershire, told HSJ the work in Somerset would test whether freedom from QOF helped areas move towards integration at greater “scale and pace”.

Asked whether the Somerset move was a pilot of a model that could be rolled out nationally or the beginning of areas being allowed to develop their own approach, Ms Prosser suggested there could be more freedom in future.

She said: “We are not abandoning QOF… What we are saying [in Somerset], and what co-commissioning will open up more of, is that dialogue with GPs about how best to deliver a whole healthcare system that meets the needs of their population locally.

“That will always be done within a framework of national standards, evidence based medicine and outcomes based commissioning. There will always be a description of the ‘what’; this and co-commissioning will lead us to different routes of how we achieve that.”