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GPs in Scotland avoid most of the negative QOF changes highlighted by BMA

Authors: Helen Jaques 

Publication date:  01 Jan 2013


GPs in Scotland will not be subject to most of the changes to the Quality and Outcomes Framework (QOF) that the BMA thinks will have a negative effect on general practice.[1]

Most of the changes to QOF recommended by the National Institute for Health and Clinical Excellence (NICE) for the 2013-14 general medical services (GMS) contract will go ahead in Scotland. However, the Scottish General Practitioners Committee and the Scottish government have negotiated “substantial amelioration” of the recommendations.

The committee’s chairman, Alan McDevitt, said, “I believe these arrangements will improve patient care and go some way to mitigating workload pressures. The success of the negotiations provides a degree of stability for developing general practice and its role in the integration of health and social care in Scotland.”

In October 2012 the Department of Health in England announced proposed changes to the 2013-14 UK GMS contract and its intention to push through changes without agreement with the BMA.[2] In December 2012 the BMA in Scotland agreed with the Scottish government a country specific GMS contract that excluded some of the changes proposed by the UK government.[3]

BMA Scotland has now published the details of these variations, such as certain indicators not being introduced and exception reporting applying to some indicators.

For instance, the new hypertension indicators HYP003, HYP004, and HYP005 (NM53, NM36, and NM37) will not be implemented in Scotland in 2013-14. The BMA’s UK General Practitioners Committee (GPC) warned that these indicators would create such a huge workload that practices would have too little time for other groups of patients.[1]

Another indicator that will not be implemented in Scotland is HF003 (NM48), which requires practices to refer patients with heart failure to an exercise based rehabilitation programme. This indicator is not being introduced because the referral service is not universally available.

The UK GPC has also expressed concern over the diabetes indicator DM013 (NM28). This indicator requires “a suitably competent professional” to hold a dietary review with patients who have diabetes. The GPC believes that implementing this indicator would mean that GPs and practice nurses would need additional training, at significant cost to practices. But the Scottish GPC and the Scottish government have agreed that no additional training will be required for those healthcare professionals who undertake dietary reviews.

The Scottish GPC has agreed to “modest” increases in the thresholds for 10 clinical QOF indicators, but no indicator will have an upper threshold above 90%, to protect against overtreatment of patients. In England thresholds will increase for 20 indicators, 14 of which will have upper thresholds of more than 90%.

The Scottish government will apply an uplift to the GMS contract in 2013-14 to allow for a pay rise for GPs and increases in expenses. The value of the uplift will be determined once the Review Body on Doctors’ and Dentists’ Remuneration has made its recommendation on doctors’ pay.

The Scottish GPC and the Scottish government have also agreed to consider, over the next 18 months, the method for allocating core funding to general medical practices in Scotland.

References

  1. Jaques H. QOF proposals are “unworkable” and “inappropriate,” says BMA. BMJ Careers  , 22 Dec 2012. http://careers.bmj.com/careers/advice/view-article.html?id=20010222.
  2. White C. Government threatens to force through GMS changes for 2013-14. BMJ Careers, 25 Oct 2012. http://careers.bmj.com/careers/advice/view-article.html?id=20009423.
  3. Jaques H. BMA agrees Scotland only GP contract. BMJ Careers, 7 Dec 2012. http://careers.bmj.com/careers/advice/view-article.html?id=20010004.

Helen Jaques news reporter BMJ Careers

 hjaques@bmj.com

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