Dr Hamish Meldrum assesses the nGMS contract after its first full year and considers what challenges may lie on the horizon

Practices have just completed their first full year of the new GMS contract and are awaiting their reward for participating in the quality and outcomes framework (QOF).

All the evidence suggests that most practices have exceeded expectations in their achievements, and in some quarters concerned voices have been heard to say that this ‘over-delivery’ is a problem and will cause financial pressures for PCOs.

If the expectations are realised, it should be a cause for celebration. It will not only be good news for practices and their patients, but it is likely to have longer term benefits for the NHS. It will demonstrate that if you give them the appropriate incentives and resources, GPs and their practices can deliver.

It will be the first time that a major healthcare system has contemplated an evidence-based, quality programme on such a scale, and many other countries are watching with interest to see just how well it works. The wealth of information on disease prevalence, the effect of interventions and the impact on health inequalities will keep researchers going for years to come.

Of course, as with any major initiative, there have been criticisms. Some have questioned why certain medical conditions have been chosen over others and suggested that this could have an adverse influence on clinical priorities.

Some have complained that the whole process is moving general practice away from what they would call its traditional art to a mere tickbox, bean-counting, pseudo-scientific chore.

There have also been complaints about some of the detail – the requirement for spirometry testing and differences over lithium levels, for example – but these have been minor given the scope of the QOF.

So, where do we go from here? The process of reviewing the QOF is already under way and a consortium composed of individuals from the University of Birmingham, the RCGP and the Society for Academic Primary Care, will consider submissions to amend the QOF.

The group will produce evidence-based recommendations as to what could be included in the new QOF from April 2006 and what might be removed. They will be supported by members of the original GMS review team who assisted in developing the current framework.

Obviously, a balance has to be struck between, on the one hand, moving the QOF forward to cover more clinical areas and, on the other, wholesale redevelopment of the scheme which would place a burden on practices as they set up new structures and protocols.

It is essential that the QOF remains evidence-based, and resistance to any attempts to include ‘evidence-light’ areas for political reasons must be robust. To what extent new areas can be included will very much depend on the resources available to develop the QOF. GPs will be keen to ensure that their work and that of their staff is not devalued.

So, one year on, can we claim the contract as a success? Certainly, it looks as though the QOF will deliver on its promises; the relief from responsibility for out-of-hours care has been welcomed; and it is likely that incomes will rise significantly.

However, there remain clouds on the horizon, among them high workload, continuing recruitment problems, the threat of the private sector and the erosion of professionalism.

Guidelines in Practice, April 2005, Volume 8(4)
© 2005 MGP Ltd
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