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QOF: Justifying the system


2 July 2013

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A few weeks ago I was speaking at the Commissioning Show in London. At the end of thirty minutes of the sort of discussion of codes, rules and financial viability that will be familiar to readers of The Commissioning Review there was some time for questions.
The first question was very pertinent but was not one for which I had prepared. Whilst I answered at the time it was not until I was on the train and passing through Slough that I really thought what I wanted to say.

A few weeks ago I was speaking at the Commissioning Show in London. At the end of thirty minutes of the sort of discussion of codes, rules and financial viability that will be familiar to readers of The Commissioning Review there was some time for questions.
The first question was very pertinent but was not one for which I had prepared. Whilst I answered at the time it was not until I was on the train and passing through Slough that I really thought what I wanted to say.
The questioner asked, from the point of view of a taxpayer and patient, what was being achieved through the QOF and what is a GPs reaction to it?
Coming at the end of a talk about codes, rules and payments per patient it was an understandable question.
I believe it's very important that practices are paid for the work that they do. Where a practice is delivering quality care, as defined by the requirements of QOF, they should receive the payment. Ultimately the way that this payment is generated is through the correct use of codes in the patient computer records.
The payment is needed by the practice to help pay for clinicians and services to patients, including those specified under the QOF. The QOF payments are around 17% of practice income and around about the same proportion of patients are on disease registers, although they probably represent a larger share of the total workload.
There are many conditions without any QOF indicators. Osteoarthritis has none, neither does liver disease. Depression has no indicator that applies more than five weeks after diagnosis. Of course practices deal with these conditions and many more besides but a practice without QOF funding will be very limited in its ability to deliver these services.
Effectively, income from QOF subsidises other activity. Increasingly, this year in particular, there are some indicators that do not cover their costs. Am I right to suggest that practices should think carefully about whether they are going to provide that service?
Every time a practice does a QOF activity that does not cover its costs there is less resource to do something else. This is true of many things that practices do; where there is a clear benefit to patients that is simply the role of the practice.
That is much less clear, for example in the case of GPPAQ exercise assessment.
If you can’t break even is there something else you would cut to do these assessments? Do you believe it would help your patients (rather than, say, a unstructured exercise assessment)? These are questions that practices need to consider.
So to answer that question, the QOF and the ways that practices tackle it are a means to an end. Despite the Health Secretary's well publicised dislike of ticking boxes there is no sign of this changing. This is by no means unique to practices. Most CCG board members did not sign up for a love of meetings and to write endless documents for authorisation and service proposals.
If you want to deliver services to patients in the NHS there are just some things you need to do.
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