Incentive schemes consultation – next steps

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We know how important QOF and IIF payments are for many London practices’ viability, and we appreciate you sharing your views.

The Government is consulting on “incentive schemes in general practice” to inform negotiations for the 2025/26 GP Contract. We recognise that this is a national issue affecting practices in many ways. As such, we will be sharing the comments you have made on the wide-ranging proposals in the consultation with colleagues at the BMA in order for London general practice’s views to be reflected in the national response.

The consultation questions suggest additional or alternative targets against which practices could be measured to qualify for “incentive payments”. Questions ask whether “incentives like QOF and IIF should form part of the income for general practice” and whether “patient experience of access could be improved if included in an incentive scheme”. It also asks “would relative improvement targets be more effective than absolute targets at delivering improvements in care quality while also addressing health inequalities?” and whether “ICBs should influence the nature of any incentive scheme?”. And seeks views on whether “there is a role for incentive schemes to focus on helping to reduce pressures on other parts of the health system?”.

Many of the questions are not easily answered in a binary way, given the diversity of general practice in the Capital and the wide-ranging patient communities served.

Whilst QOF participation is technically optional, it is clear from your responses that many practices would not be viable without this income. Until the costs of running a practice are met from core funding, several responses to us expressed the view that voluntary participation in QOF and IIF is not truly voluntary. Rather than being reliant on these schemes to supplement core income, a popular view was that such targeted payments or “incentives” could be separated into recognition of the activity involved in reaching specific patient communities and attempting the work, the overheads involved in attempting the work, and success relative to the starting position in a locality rather than against an immobile national measurement.

When absolute thresholds are used for assessing QOF and IIF “success” (with some minor adjustments) this can result in the omission of the hardest to reach, and/or those in most need of an intervention, given the additional resource and cost involved in reaching these groups under the current regime comparative to engagement with other groups. For those with large numbers of hard-to-reach groups or patients and/ or practising in deprived areas ‘relative’ rather than ‘absolute’ targets were deemed preferable, with comments about how much harder it is to achieve in full of challenging QOF targets in several inner-city areas ranking high in UK IMD rankings.

Concern was raised about the increase in chronic disease monitoring and management and in proactive care without the provision of additional/sufficient resources, but with the fear of financial penalties if this significant increase in preventative and proactive activity is not delivered. This went hand in hand with concern about confusion for QOF measurement of unfunded activity

Responses to PCN level incentive schemes were largely negative, citing the pre-eminence of the GMS/ PMS contract and the practice to PCN structures and delivery contracts.

The consultation closes on 11:59pm on 7 March 2024.

Should you wish to submit your own response you can do so here.