Some of my points are missing

Yesterday the changes to the GMS contract for the year from the first of April came out. there are quite a few of them and the full details are on the BMA contract page. Of course I turned to the QOF changes first of all. You can read the full QOF changes here.

You can almost feel the negotiations behind them. Raising the upper threshold on three indicators from 70% to 71% seems likely the result of a very long and banal meeting. Other areas have other minor differences and some, such as mental health see big changes. There is also a lot of "to be announced" around prescribing and referral audits.

I am trying to write and article for a trade magazine about the changes but I have hit a problem. The numbers just don't add up.

Page one goes pretty much as billed with 92.5 points being removed. Page two then gets a little odd. CHD11 (ACEi after MI)become CHD14 with 3 extra points. DM9 (foot pulses) gains a point but also does most of what DM 10 currently doing. Is this duplicated or is there another three points lost here? So at the end of page two we have lost 92.5 or possibly 95.5 points and gained 4.

Page three - MH 9 gains four points in its split up but depression loses 20. So total 8 gained and 112.5 (or 115.5) down.

Page four has lots of new indicators so gains 40. Now 48 up.

Page five gains 48.5 but loses another 4. Final total 96.5 gained with at least 116.5 lost. 20 points have gone adrift somewhere. Even worse there may be another 3 if they don't want to pay twice for foot checks. And actually I wonder whether they will really want to have two indicators for aspirin and beta blockers in CHD which would lose another 14.

So where are my 20 points?

Updated 14/3/11 They have been found and it seems to have been the slip of a keyboard. QP9-11 which relate to reviewing emergency admissions should have 47.5 rather than 27.5 points. That is a lot of points, nearly 5% of QOF - more than all of asthma.