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Blog: QOF thresholds


11 December 2012

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All GPs should have received an email from Laurence Buckman this week about the government's proposed changes to QOF, which the General Practitioners Committee oppose. In the letter he estimates the loss to a typical practice (5,651 patients in England) of £31,000. Of this, £20,000 was down to the removal of the organisational domain. The remaining £11,000 would be down to increases in the QOF thresholds.

All GPs should have received an email from Laurence Buckman this week about the government's proposed changes to QOF, which the General Practitioners Committee oppose. In the letter he estimates the loss to a typical practice (5,651 patients in England) of £31,000. Of this, £20,000 was down to the removal of the organisational domain. The remaining £11,000 would be down to increases in the QOF thresholds.


While the amount of loss from the organisational domain will be fairly consistent from practice to practice, the effect of threshold changes is likely to be much more variable.


If the number of points remain the same, this expansion of the thresholds will reduce the point value, and the cash, for every patient in the range that meets the target.


The proposal currently out for consultation is that the thresholds should rise to the level of the upper quartile – that is to the level of achievement of the current top quarter of practices in that indicator.


The plan is that this should be introduced over two years; the full changes will take effect in the 2014-15 QOF year.


As the data for the QOF year ending April 2012 has now been published, we can get an idea of where the quartiles are. It is not clear whether these will be calculated separately in each of the four countries. I have calculated separately for England, Scotland and Wales. It is by no means certain that Scotland will make these changes at all. Data for Northern Ireland is not yet available. If a UK-wide approach is taken, then the figures will be very close to those given here for England.


There are several cases where the thresholds could increase to 100%, particularly in those areas that have small numbers of patients.


Achievement of clinical outcomes such as blood sugar levels or blood pressure targets has always been significantly above the thresholds. This is likely to lead to quite large increases in these thresholds, typically 15-20%.


Practices who are in the top quarter in one indicator are more likely to be near the top in other areas. They will be less affected by these changes and see an income drop of less than the £11,000 average.


Practices who are struggling, perhaps working with patient populations with more difficult-to-control disease, will see a greater drop in income.


Nothing on the scale has been seen before in the QOF. It is not clear how much of an increase in real clinical results will result or if there will simply be an increase in exception reporting rates.


These are not small changes. There is substantial dilution of the payment to practices for each patient getting to target. I discussed the business case for QOF indicators in the latest issue of GP Business. As the incentives a reduces some practices may find it simply not worth chasing the all of the points in the coming years.

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