There is a little appetite among clinical commissioning groups to move their member practices off the national GP pay for performance framework, despite recently being given powers to do so, HSJ has found.

  • No CCGs with the power to do so to replace national quality and outcomes framework this year
  • Health secretary criticised the framework last week
  • GP bodies say there is “nervousness” about replacing QOF

CCGs that took control of their primary care budgets in April, under delegated commissioning arrangements with NHS England, are permitted to replace the national quality and outcomes framework for GPs with a “locally designed incentive scheme”. However, they have overwhelmingly chosen not to do so.

This is despite the health secretary voicing his dissatisfaction with the QOF over recent years.

HSJ asked all 63 groups that have taken on this responsibility whether they have introduced, or plan to introduce, a local incentive scheme for GPs to replace all or part of the QOF.

Ditch QOF

Out of the 59 CCGs that responded, none have yet implemented a local scheme and none have firm plans to do so this year. Only three - Dudley; Greater Preston; and Chorley and South Ribble - plan to introduce one in 2016-17. Leicester City CCG said it was “looking at the options” for a local framework for next year, and Fylde and Wyre CCG is “considering changes”. Castle Point and Rochford CCG said it “anticipated” reviewing the QOF and bringing a scheme in next year.

West Leicestershire CCG is “considering a replacement” to the QOF, but it is in “the very early stages” of talks so any changes would not apply until 2016-17, a spokesman said.

The remaining groups either had no intention to replace the QOF or were undecided.

Four CCGs - Durham Dales, Easington and Sedgefield; Barnsley; Portsmouth; East Lancashire - have either begun or plan to implement local incentive schemes to run alongside the existing national framework rather than replacing it.

NHS England last year gave permission for GPs in Somerset to stop reporting against the majority of QOF indicators in favour of a locally developed approach, which at the time was seen as a significant departure for the national body.

The British Medical Association warned the controversial move could lead to the “Balkanisation of national healthcare”.

In a speech last week Jeremy Hunt said: “The quality and outcomes framework was meant to provide a better focus on outcomes, but has too often ended up as a tick-box process.”

Richard Vautrey, deputy chair of the BMA’s GP committee, told HSJ last week it was “not a surprise at all” that CCGs were lukewarm about ditching the QOF.

“They’re hopefully listening to their [member practices] that will be telling them what they don’t want to do is to replace one quality system with something that is potentially more onerous and burdensome.”

Amanda Doyle

There was ‘no point replacing one set of indicators with another, with no better evidence’, Amanda Doyle said

He said the “biggest concern” about losing the QOF would be that “patients would be uncertain what level of care they would be getting [from] area to area”.

“You would end up with a postcode lottery of care, and a patient with diabetes, heart disease or lung disease wouldn’t be certain if they move from one area to another that they would get the comparable level of care,” he added.

Speaking at the NHS Confederation Conference earlier this month, NHS Clinical Commissioners co-chair Amanda Doyle said there was “a bit of nervousness that the evidence supporting local [incentive schemes] isn’t particularly robust”.

“The QOF is a pot of money that can be used to incentivise different behaviours [and] different ways of providing services,” said Dr Doyle, who also chairs Blackpool CCG. There is “no point just replacing one set of indicators with another, with no better evidence”, she added.