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CCG’s localist approach could herald greater flexibility

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Allowing GPs in a single clinical commissioning group to break away from the nationally agreed quality and outcomes framework will test whether the approach could help drive integration and support co-commissioning, LGC’s sister title Health Service Journal has been told.


Last week HSJ revealed that NHS England had approved a local alternative to the framework for practices in Somerset.

Details of the Somerset Practice Quality Scheme agreement – seen by HSJ – stated that practices that chose to take part would only have to formally report against five of the indicators in the 2014-15 QOF.

Payment of the additional QOF funding will be based on quarterly reports from practices on their progress developing integrated care for people with long-term conditions, reducing avoidable hospital admissions and improving general practice sustainability.

Linda Prosser, NHS England’s director of primary care in Bristol, North Somerset, Somerset and South Gloucestershire, said NHS England had a “high level of trust” in Somerset GPs, and anticipated continued high achievement of QOF indicators “because they’re evidence based”.

She said work in Somerset would test whether freedom from QOF helped areas move towards integration at greater “scale and pace”, and would also inform the co-commissioning of primary care by NHS England and CCGs in the future.

Ms Prosser said: “We are not abandoning QOF… What we are saying [in Somerset], and what co-commissioning will open up more of, is dialogue with GPs about how best to deliver a whole healthcare system that meets the needs of their population locally. There will always be a description of the ‘what’; this and co-commissioning will lead us to different routes of how we achieve that.”

The QOF indicators are designed to incentivise best practice in the care of people with long-term conditions; compliance generates significant extra income for practices. However, it is unpopular due to bureaucracy involved in reporting and validating the data.

A number of CCGs said they were interested in following Somerset’s lead, despite NHS England stating the freedoms would not be replicated in any other part of the country during this financial year while impact is evaluated. Thanet CCG approached its NHS England area team to develop a QOF alternative, but it was rejected.

Thanet’s accountable officer Hazel Carpenter said the CCG would continue to develop the a business case “so we can take the opportunity when the circumstances change”.

She said being able to control and localise QOF would be a “significant opportunity in terms of co-commissioning”.

Mark Hayes, chief clinical officer at the Vale of York CCG, said his organisation was also interested in more freedom from QOF and accused NHS England of being “narrow” in only allowing Somerset the freedoms during 2014-15.

 “Our strategic plan is moving towards moving towards a care hub… If we could motivate practices by linking activities aligned to that with the QOF payment, that would be helpful,” he said.

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