Why the Contractor Population Index matters, and how they got it wrong.

The Contractor Population Index, like most things that are working well, has not attracted much attention until now. Its purpose has been to make sure that the cash value of a QOF point takes into account the size of the practice. A practice with ten thousand patients should, all other things being equal, get twice as much for each QOF point as a practice with five thousand. Changes and mistakes in how this is calculated will cost practices thousands of pounds.

Until April 2013 an “average” practice in England was considered to have 5891 patients ( the three other countries used their own values). Effectively QOF was paid in blocks of 5891 patients. In the first year of QOF a point was worth £120 per 5891 patients, or just a shade over 2p per patient. This value gradually increased over the following years. It didn’t actually matter what an actual average practice list was, we were effectively being paid per patient.It simply made the contract easier to present when larger numbers were used.

Autumn 2012 probably represented the lowest point in relations between the GPC and the Department of Health. The contract imposition at the time was wide ranging. In paragraphs 33-35 of the letter from Richard Armstrong in December 2012 it was proposed to change the 5891 figure based on the actual average list size. This was stated as requiring an increase of 16% - 6834 patients. The actual figure was to be calculated on the first day of January before the QOF year began. In the long term the trend is for average lists to rise if the population increases or smaller practices close. Of course if the cash value of a point stays the same it is spread between a larger number of patients and the value per patient will fall. For one year only there was to be an increasein the value of a QOF point. Mr Armstrong’s letter stated that “This would be a cost neutral change in 2013/14.”

In the end the average list size on 1st of January was 6911 - an increase of 17.3%

When we received the calculation from CQRS last week there was another problem. Whilst both the imposition letter and the Statement of Financial Entitlement (the document that lays out what practices should be paid in exhaustive detail) say that the average list size before the start of the QOF year should be used (i.e. 1st January 2013 for the year just gone) the HSCIC have instead used 1st January 2014. As the trend to larger lists has continued they have used an average list size of 7052 - a 19.7% increase on the old figure. That sixteen percent increase in the value of a point is being stretched even further. For a 10,000 patient practice this would represent more than £3,500 loss.

This loss is simply an incorrect interpretation of the rules and was sorted within a week.

There is, unfortunately, a further sting in the tail. That figure from the first of January 2014 will be used for QOF payments in April 2015. Thanks to HSCIC we now know there will be 2% less money per patient. Even with the new, slimmer, QOF this decrease will wipe out the majority of the 0.28% uplift to GP payments this year.

Letter from the HSCIC now amended to the correct date..

Statement of Financial Entitlement 2013

The "Cost Neutral" promise