GP representatives have condemned the government’s proposals for changes to the Quality and Outcomes Framework.
The British Medical Association’s General Practitioner Committee claims they could lead to greater health inequalities, a postcode lottery in healthcare, and damage the GP-patient relationship.
The GPC’s official response to a Department of Health consultation says a moratorium on change is needed to allow adequate time for negotiation.
The DH plans to change the QoF by putting the National Institute for Health and Clinical Excellence in charge of reviewing new and existing indicators from April this year.
NICE would collect evidence, prioritise new indicators and ensure that that existing indicators were regularly reviewed. It could publish a menu of recommended indicators each year.
The DH then proposes that primary care trusts should be allowed to select additional indicators from the national menu to reflect local priorities.
The GPC said localising the QOF could be “seriously detrimental to the already reduced gap in health inequalities” achieved by the framework and that it could also threaten consistency of care.
Its response states: “It is concerning that NICE, a body primarily set up to ensure an end to post-code prescribing and health authority rationing of healthcare, is to be mandated to produce guidance which will actually inform and support the regional variation of healthcare.”
The GPC also claims the amount of IT support required locally to introduce regional variations “is such that this alone ought to ensure that the decision is made to maintain a national QoF.”
The GP leaders further question NICE’s proposed role in QoF, although they feel a decision appears to have already been made.
The GPC response states: “We do not believe that NICE is a body completely independent of government influence and do not feel that it would do a better job than the current independent expert group.”
The GPC claims that involving NICE could mean decisions on indicators are based on political imperatives, affecting professional confidence in the QoF process and undermining the professional relationship between GPs and patients.
The GPC also says that proposals to take away funding from indicators once they have become ‘embedded’ in general practice would threaten future continuation of that work with staff salaries paid for from QoF funding.
The BMA is encouraging all GP practices and local medical committees to respond to the consultation, which ends on 2 February.
Dr Laurence Buckman, GPC chair, said: “It is vital all LMCs respond to this consultation. Even though this is an English consultation, the proposed changes will have an impact on QOF across the UK. As it stands the changes proposed in this consultation will create rather than get rid of health inequalities.”
The DH’s consultation on QoF
The GPC’s official response