More on QOF contract changes

The full details of the English government's enforced contract changes were released today. You can read my annotated version of the letter. Most of the changes were what was expected, certainly in relation to the QOF. There is plenty in the medical media about the changes as well. Here are a couple of bits you may have missed.

There is a plan to renumber the indicators to make them neater. So this years diabetes 31 may be next years diabetes 5. Seems a recipe for confusion and generating extra work at the Commissioning Board to me. Actually seems like a bit of work reprogramming the website to me too!

More serious is the CPI in QOF. For practices with average prevalence there is a certain amount of cash per patient for each point. When the QOF was originally devised this was not really a headline amount so it became £120 or so per typical practice of 5891 patients (5885 in Wales, 5095 in Scotland and 4937 in Northern Ireland)

£120 per 5891 patient is simply a way of saying 2p(ish) per patient. As the value of points rose over the years so did this payment per patient. Practices got bigger on average (whatever the pros and cons, smaller practices are simply not in fashion) but that did not matter. It was still 2p per patient. The government was paying no more, and no less than it planned to for each registered patient.

In the letter the government plans to increase the average list size by 16% and the payment per point by 16%. They say this will be cost neutral in 2013/14, and it will. They are still paying 2p per patient.

In each future year the average will likely rise again. However the value per
point will be by negotiation. Essentially there is not guarantee that the payment per patient will not fall as the average practice size rises. It will depend on negotiations producing a similar rise in point value.

I can see no reason to change this other than as a little time bomb in the future (but then I can't see why you would want to renumber all the indicators. I may not be in the DH mindset.)

This is an obscure part of the calculation although it can't really be said to be hidden - it is there three times- it is easily missed.

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