NHS England’s most senior GP leaders have criticised the national GP pay for performance framework as ‘bad for health’. Clinicians should instead be incentivised to work more closely with other parts of the health system, they said.

Speaking at a Westminster Health Forum event in London yesterday, NHS England deputy medical director Mike Bewick said he thought “[the quality and outcomes framework] is becoming bad for health”.

He said the framework, known as QOF, had “reached the point” where it needed to change from “looking at how to use indicators for incentives” to “using indicators for improving care”.

Mike Bewick

QOF is ‘probably here to stay’, Mike Bewick said

However, he conceded “QOF is probably here to stay”.

“We should be developing indicators that are not always linked to incentives, but how we advance professionals working together… to deliver better care,” he suggested.

Speaking at the same event, NHS England’s head of primary care commissioning David Geddes said the national body was keen for clinical commissioning groups to take up fully delegated responsibility over GP services in order to “[move] away from process commissioning and [look] at outcomes commissioning”.

He explained: “What need to be doing is moving away from saying as a GP you get paid for a QOF point, and it’s a tick of a box, and instead, as a GP you get paid for working with your acute trust or a mental health trust to get an outcome which is different for your patient.”

Dr Geddes said such a move would “create the interdependence that we need between services”, but it would also require a “much more sophisticated kind of commissioning” and “we need to understand what the contractual barriers are for that”.

CCGs should have “ownership” over this “place based commissioning”, he added.

Last year NHS England gave permission to GPs in Somerset to stop reporting against the majority of QOF indicators in favour of a locally developed approach.

The move was seen as a ““significant departure” for NHS England, and proved controversial. The British Medical Association warned it could lead to the “Balkanisation of national healthcare”.

NHS England has enabled CCGs taking on delegated responsibility over primary care to follow Somerset’s example.