The Government must ‘trust’ GPs to use funding as they see fit rather than setting up ‘small, disconnected pots of money’, an influential group of MPs has been told.
Today, the Health and Social Care Committee heard evidence on what actions the Government and NHS England must take to shift more care from hospitals into community settings – a key ambition of its upcoming 10-year plan.
When MPs asked how to ‘incentivise’ this shift in the system, GP leaders and experts argued that the current quality and outcomes framework (QOF) fails in its aims and has ‘run its course’.
MPs also heard calls for more funding into core general practice, with GPs trusted to use this money in the best interests of patients.
RCGP chair Professor Kamila Hawthorne repeated the college’s calls for more GPs and better retention strategies, and also urged the committee to recommend the introduction of a ‘general practice investment standard’.
Professor Hawthorne said this should be similar to the mental health investment standard, requiring ICBs to report ‘on an annual basis the percentage of budget that’s coming out into general practice’ with a commitment to increase funding ‘year on year’.
On general practice incentives, she said: ‘We’re obviously thinking a lot about the QOF system, which I think has now run its course, and we need different incentives now, perhaps including some sort of quality improvement type incentive on continuity of care, because we know that good continuity of care keeps people out of hospital.’
The RCGP’s recent submission to the Government’s consultation on the 10-year health plan called for a review of all GP funding streams, including the QOF, and the college’s former chair told a previous health committee in 2022 that the scheme should be scrapped.
Beccy Baird, senior fellow at the health think-tank The King’s Fund, also criticised QOF, arguing that it ‘doesn’t really measure quality’ but instead ‘measures process’.
‘It doesn’t measure outcomes either, despite being called that – it measures process,’ she told the committee.
Ms Baird said there should be ‘basic quality standards’ for general practice and community care, but that the focus should be on outcomes, which ‘need to be the same wherever you are, but the way you might achieve those outcomes can well be different’.
She also said she is ‘very wary of micro-financial incentives’, which England relies on ‘hugely compared to other countries, particularly in general practice’.
‘The danger of all these small, disconnected pots of money is it stops practices and communities being able to really address the needs of their patients,’ Ms Baird told the committee.
As well as the QOF, she also pointed to the Additional Roles Reimbursement Scheme (ARRS), which she said is a ‘wonderful thing’, but that without more core GP funding, practices ‘end up with a really unbalanced team’.
Ms Baird continued: ‘I’d much rather see a much more devolved system, which trusts general practitioners to use the money that’s given to them on a capitated basis, and they’re held accountable, as are the local commissioners.’
According to Ms Baird, funding is currently used for ‘very prescribed, specified services’ and ‘trust in the system has disappeared a little’.
She said: ‘I think there’s a definite sense that “we won’t fund general practice too much, because what if they don’t spend it right? What if they don’t do what we want them to do? What if they do the wrong things?”
‘But actually, people in the health and care system want to do right by their patients. The people who know what patients and the community need are largely the people closest to them on the ground.’
The previous Government ran a consultation on the QOF from December to March this year, asking respondents whether the incentive scheme should be scrapped altogether.
In Northern Ireland, the Government has recently scrapped QOF and moved the £40m of funding into the core GP services and indemnity.
GP leaders at the recent England LMCs conferenced called for the return of all ARRS funding into the core GP contract, arguing that it has ‘failed to provide meaningful support’ to practices.
This seems like an unexpected burst of common sense.
Steve Jobs famously said, “It doesn’t make sense to hire smart people and then tell them what to do; we hire smart people so they can tell us what to do”.