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Scottish government vows ‘to overhaul QOF’
The Quality and Outcomes Framework (QOF) in Scotland may be overhauled to focus on the country’s public health priorities, under the Scottish government’s bid to negotiate much of the GP contract on its own terms.
It is understood that Holyrood wishes to seize control of negotiations for three quarters of the GMS contract; after citing irreconcilable differences with the NHS reforms in England. This could involve a large-scale reconsideration of the QOF in Scotland, with big changes planned for the framework to refit the scheme for Scottish GPs.
A change of this scale could affect up to 40% of QOF points, including the quality and productivity indicators.
Chairman of GPC Scotland, Dean Marshall, said:
‘The Scottish government’s view is that the health agenda is so diversified across the UK now that it causes difficulties for the UK contract’.
Dr Marshall also described how the Scottish’s government’s proposals would retain the UK contract but seek to increase the ‘flexibility’ to tackle public health issues prioritised in Scotland, such as alcohol abuse. He said:
‘What it’s said to us is: it wants to maintain a UK contract but increase the flexibility to do [things] differently.’
Scottish health secretary, Nicola Sturgeon, said:
‘My proposal is not to recast the structure of the contract but instead to repatriate aspects of the annual negotiation in order to introduce change in some important areas – in particular public health and the standards of care set out in the organisational indicators – and to leave on a UK basis the indicators for good clinical care’.
GPC Scotland said it believes the Scottish government will seek to transform indicators relating to the current organisational domain to reflect differing priorities in the country. These indicators currently include records, education and medicines management.
This would mean Scotland would have to negotiate its own terms for the new quality and productivity (QP) indicators, which also form part of this organisational domain and were introduced earlier in the year.
The QP indicators were introduced by the DH to meet England’s £20 billion efficiency drive under the QIPP programme. But plans to link A&E attendance to QOF payments from 2012 have been criticised by GPs as they may fall outside their control. Ministers in England had also announced in November last year that up to 15% of QOF would be dedicated to public health measures from 2013.
According to Dr Marshall, it is these measures that the Scottish government believes to be too Anglo-centric, and it wants its own version to tackle what are seen as different priorities for Scotland.
Changing organisational and public health domains to suit Scottish interests would mean around 40% of QOF would be nationally determined, outside of overall UK control.
Although the Scottish government has yet to confirm the details of the proposals, it has said it will be consulting with the BMA over the next three months and was ‘keen to hear the views of GPs from around the country’.
Earlier this month, GPC leaders in Scotland, England, Wales and Northern Ireland had said their preferred option was to retain the UK-wide deal, but that England’s reforms put this at risk.
In June, the 2011 LMCs conference also voted to maintain a UK-wide deal.