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

QOF error in your favour - receive £???

This statement has appeared on the Primary Care Contracting site

An error has been identified within the QMAS system which calculates payments to GP contractors under QOF and which has resulted in GP practices being underpaid for achievement under the QOF additional services indicators since 2004/05. The Department of Health will provide PCTs with resources to make good these underpayments.

... and that is all we have. There is no detail of what the error is. The additional service domain contains Child Health Surveillance, Cervical Cytology and Contraception/Sexual Health. There is a prevalence adjustment here and I would guess that that is where the problem is.

It is worth noting that this seems to have purely been an underpayment and some practices could be due six years of back pay.

QMAS is used to calculate the QOF in England and Scotland although PCC only deals with England as far as I know.

A notice on QMAS says the system will be off for a couple of days from the 11th February. I have no idea if this is connected.

More business rules strangeness - PP1

My thanks to Dr David Fitzsimons who has pointed out that it is not only depression that has suffered a ruleset that differs from the guidance. PP1 - the assessment of CVD risk in patients newly diagnosed with high blood pressure - features an almost identical change. Whilst the guidance suggests only the patients diagnosed in the past year should be counted the business rules carry forward all of the unassessed patients from the previous year. There is not a lot that a practice can do to avoid this, unless of course their hypertension has resolve (read code 212K ) in the meantime.

Smoking recording - don't panic

It is only two weeks until the final collection of data for payment for this year. However it seems that this will not be collected correctly, at least in the case of smoking status. Appearing in the less than grippingly titled QMAS End of Year Communication is the revelation that the business rules have been incorrect this year and that there is not enough time left to correct them.

Don't panic though. There will be new searches put in by the GP computer system suppliers and put into QMAS (and presumably the separate systems in Wales and Northern Ireland) at some unspecified point in the future. This will inevitably increase the number of points to each practice. No practice will lose due to these changes. Practices need to make sure they look out for when to correct this data and that their PCTs remember to give them the opportunity.