QOF proposals are “unworkable” and “inappropriate,” says BMA

Authors: Helen Jaques 

Publication date:  22 Dec 2012

Proposed changes to the Quality and Outcomes Framework (QOF) for the 2013-14 general medical services (GMS) contract were “unworkable” or “inappropriate,” the BMA’s General Practitioners Committee has said.

In October the government announced a raft of changes to the GMS contract for 2013-14, which it intended to impose without the BMA’s agreement.[1] The BMA has called this approach “hugely damaging.” The deputy chairman of the General Practitioners Committee, Richard Vautrey, said that the committee had concerns “not just in terms of additional workload” but also with the way that government officials had blindly accepted recommendations of the National Institute for Health and Clinical Excellence “without the sensible and pragmatic modifications that we were suggesting.”

Vautrey said, “Some of the things the government are talking about are things that we could support if we were in a situation where we were working with them and finding ways to improve the care to patients.

“But [the government isn’t] interested in that; all that it is interested in is in demonstrating that efficiency savings have been made.”

The committee pointed out that some of the proposed QOF indicators required general practices to refer patients to services that were not universally available across the UK, making it impossible for practices in certain areas to achieve the associated points. This was the case for indicator COPD006, which requires practices to refer patients with chronic obstructive pulmonary disease to a pulmonary rehabilitation programme.

Several of the proposed hypertension indicators could have such a huge effect on workload that they could skew healthcare towards a certain section of the patient population at the expense of other patients, the committee said. Achieving indicators HYP004, HYP005, HYP003, and BP001 would require more frequent or longer appointments and generate extra paperwork, reducing the time available to GPs for other patients, the committee argued.

Indicator DM013, which requires practices to hold a dietary review with people who have diabetes, would necessitate additional training for GPs and practice nurses, which in turn would add “significant” extra costs for practices and take staff away from clinical care, the committee said.

Two of the proposed indicators relating to people with diabetes who have erectile dysfunction (DM015 and DM016) would require that GPs remind patients annually about erectile problems, an approach the GPC called “repetitive” and “unnecessarily insensitive.”

The GPC plans to highlight these issues in its response to the consultation on the new contract. It has also encouraged GPs and practices to respond individually to the consultation.


  1. Jaques H. Government announces details of new GP contract for England. BMJ Careers  , 9 Dec 2012. [Link] .

Helen Jaques news reporter BMJ Careers


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