News / Commission: PCTs must address QOF oversight

The quality and outcomes framework (QOF) may be failing patients and taxpayers because of poor oversight by primary care trusts, the Audit Commission said.

Under QOF, GPs are paid for achievements against a number of criteria, such as the percentage of coronary heart disease patients treated with a beta-blocker. However, a commission briefing, Paying GPs to improve quality, said some PCTs could not be sure QOF payments were correct, justified or delivering good value. And patients may not be receiving services that should be delivered to them.

PCTs that checked QOF claims and arranged for a suitably trained GP to visit practices each year to examine evidence for the claims had a clear idea of the impact

on patients and whether the payments were being properly and fairly made.

Exceptions, where GPs can exclude from QOF returns patients who refuse to attend reviews, or where medicines in the QOF indicators cannot be prescribed for medical reasons, was one of the main areas of inconsistency. Exception levels between PCTs varied between 3.8% and 7.6%. Levels between practices varied even more.

The commission said some variation can be expected, but PCTs must act to ensure that patients are only exception-reported for legitimate reasons. Otherwise, some patients will not be receiving the treatment and care they need.

‘The best can be confident that they are spending the money well, GPs are getting the rewards they deserve and patients are getting the services they need,’ said Andy McKeon, the commission’s managing director of health.

‘But in some areas that isn’t the case and patients may be missing out because of poor administration of the scheme.’

In a separate report, published this month, the commission urged the NHS to tackle levels of sickness absence. Managing sickness absence in the NHS found variations in rates between types of trusts and within departments in the same trust.

NHS bodies in the north of England and in areas with the highest deprivation had greater levels of sickness absence.

The NHS in England could save £290m, increase staff productivity and improve morale by understanding and tackling the causes of variations in sickness absence across the service, it added.