Take time to review the QOF’s practice management section and make sure that it is working to the benefit of your practice and patients, says Dr Nigel Watson


During the past year, practices have worked hard to try to gain maximum points for the organisational indicators of the nGMS contract’s quality and outcomes framework (QOF). So it is worth taking an objective look and evaluating whether these indicators have made a difference within the practice and if any further work would be helpful.

Practice management is one of the five areas that make up the organisational indicators.1 The section consists of 10 indicators worth a total of 20 points (Table 1, below). In 2005/6 each point is worth about £125, so if maximum points were achieved the average practice of 5891 patients would receive approximately £2500.

Child protection procedures – Management 1

GPs will be aware of the events that surrounded the tragic death of Victoria Climbie in 2000. In his report of the inquiry into the circumstances of her death, Lord Laming was highly critical of the child protection procedures.2 Since then, many PCOs have worked closely with their local social services departments to review their procedures; however, few GPs have been involved in the process.

When dealing with a child who may be in need of protection, GPs often feel caught between the need to preserve the element of trust essential in looking after a child and his or her family, and their duty to act on their concerns.

The indicator stipulates that practices should have access to a copy of local child protection procedures and know how to use them. However, GPs may feel that this is not sufficient, and may find it more useful to meet professionals from the local child protection service to discuss issues of mutual interest. Our practice did this last year and found it very helpful.

It can also be useful to present a fictional case at the primary healthcare team meeting and discuss how the practice would handle it.

Backing up data – Management 2

This indicator requires that practices have arrangements for backing up data, and your practice will almost certainly have such a policy.

Table 1: Practice management indicators



Management 1


Individual healthcare professionals have access to information on local procedures relating to child protection


Management 2


There are clearly defined arrangements for backing up computer data, back-up verification, safe storage of back-up tapes and authorisation for loading programmes where a computer is used


Management 3


The hepatitis B status of all doctors and relevant practice employed staff is recorded and immunisation recommended if required in accordance with national guidance


Management 4


The arrangements for instrument sterilisation comply with national guidelines as applicable to primary care


Management 5


The practice offers a range of appointment times to patients which as a minimum should include morning and afternoon appointments five mornings and four afternoons per week, except where agreed with the PCO


Management 6


Person specifications and job descriptions are produced for all advertised vacancies


Management 7


The practice has systems in place to ensure regular and appropriate inspection, calibration, maintenance and replacement of equipment including:

  • A defined responsible person
  • Clear recording
  • Systematic pre-planned schedules
  • Reporting of faults


Management 8


The practice has a policy to ensure the prevention of fraud and has defined levels of financial responsibility and accountability for staff undertaking financial transactions (accounts, payroll, drawings, payment of invoices, signing cheques, petty cash, pensions and superannuation etc.)


Management 9


The practice has a protocol for identifying carers and a mechanism for the referral of carers for social services assessment


Management 10


There is a written procedure manual that includes staff employment policies including equal opportunities, bullying and harassment and sickness absence (including illegal drugs, alcohol and stress), to which staff have access


However, it is important to evaluate whether it is practical and effective.

Recently, a practice in Wessex found that the hard disk on their clinical server was corrupt. They had made regular back-ups, so thought that they would be able to restore the data.

Unfortunately, the back-up tapes had not been working properly and were never verified.As a result, the practice lost over 12 months’worth of clinical data.

Hepatitis B status – Management 3

Under this indicator, practices are required to show evidence of the hepatitis B status of all relevant practice- employed staff, to recommend immunisation if necessary and check response to vaccination.

‘Staff’ should be interpreted as any doctor or other team member who is deemed to be at risk after a risk assessment has been carried out.

Indeed,GPs,as employers, are obliged by the Health and Safety at Work Act 19743 to ensure that their employees receive training and know the procedures for safe working, and this covers situations where staff have direct contact with patients’ blood and other potentially infectious bodily fluids or tissues.

Check that your practice has a register and that it is up to date and includes everyone who may be performing exposure-prone procedures. The Department of Health guidance on hepatitis B risk and immunisation can be found at www.doh.gov.uk/pub/docs/dph/chcguidl.pdf.

Instrument sterilisation – Management 4

Concerns about MRSA and the possibility of transmission of vCJD during operative procedures have increased over the past few years, and a significant amount of work has been done to address the risk in hospitals. However, the risk in general practice is lower.

Wound infection rates are much lower in general practice, and this is partly because of the environment but also because the general health of the population undergoing minor surgical procedures is better.

The indicator stipulates that arrangements for instrument sterilisation should comply with national guidelines applicable to general practice, but as yet no such guidelines exist.

Appointments – Management 5

If your practice offers a range of appointment times on a minimum of five mornings and four afternoons a week, and advertises this in the practice leaflet, you already meet the requirements of this indicator.

However, in response to the problem of restricted advance booking of GP appointments, brought to light during the general election earlier this year, the Department of Health has announced measures to guarantee patients the choice of an advance appointment. The 24/48 hour access target should not be achieved at the expense of all advance booking.

Job descriptions – Management 6

This indicator aims to ensure that practices maximise their chances of employing the right person and do not fall foul of legislation including the Sex Discrimination Act, Equal Pay Act, Disability Discrimination Act and Race Relations Act.

Most practices follow good employment practice when recruiting staff; however, for all practices it is worth reflecting on whether you achieve every aspect of this indicator. Failure to do so could cost you significantly more than the points on offer.

Evidence points to a significant rise in claims for discrimination on grounds of sex and race, and with recent changes in the law on disability, discrimination claims are likely to increase in this area, too. It is also good practice not to discriminate on the grounds of sexual orientation, religion or age.

Box 1: Practice management indicators


A practice required only one partner to sign cheques.To be helpful, the GP signed several blank cheques. Fortunately, the practice manager was honest and no fraud took place

Always have two signatories, keep the number of authorised non-partner signatories to a minimum, and ensure that signed cheques are accompanied by an invoice


One member of a practice’s staff was responsible for authorising the payroll.They altered their own payments, increasing them by a total of several thousand pounds

Always require two people to administer the payroll

Income and expenditure

A practice lost £50 000 because the partners had never reconciled their income and expenditure. A new partner decided to do this and found unpaid bills dating back over a long period, and that staff were able to order any equipment they wanted without a financial limit

Always reconcile income and expenditure, and ensure that staff get a partner’s approval before purchasing items over a certain limit

The following websites contain useful guidance on recruiting without discrimination: www.eoc.org.uk (The Equal Opportunities Commission); www.acas.org.uk (Advisory, Conciliation and Arbitration Service;ACAS); www.drc-gb.org (the Disability Rights Commission); www.disability.gov.uk (for information on the Disability Discrimination Act) and www.cre.gov.uk (The Commission for Race Equality).

Equipment – Management 7

This indicator is straightforward – practices need to have a system for regular maintenance, calibration, inspection and replacement of equipment.

All equipment should be recorded, and the practice should agree on a regular schedule of ongoing maintenance. The schedule should identify the individual with overall responsibility and those whose task it is to inspect or maintain each piece of equipment. It should also specify the intervals between inspections and include a system to report faults.

The PCO is now responsible for all IT equipment and should ensure that it is maintained and replaced when necessary.

Software is available to help practices record the schedule for maintenance. Many practices already use the iQ Practice Manager portfolio, which includes software for this task.4

Fraud – Management 8

All practices are vulnerable to fraud, and over the past 10 years there have been numerous examples of practices falling victim to fraudsters and losing considerable amounts of money.However, a policy to prevent this happening does not need to be complicated.

Box 1 (above) gives some examples of issues I have dealt with as LMC Chief Executive over the past year.

Most practices have a partner who is responsible for finance, and he or she should work closely with the practice manager on financial matters.

Carers – Management 9

Management 9 is probably the indicator that most practices have found easiest to achieve. However, many have struggled to gain any real benefit for the patients, their carers or the practice.

The practice should have a protocol to identify carers and record those with special needs, and establish a mechanism for referral to social services for assessment.

It is clear that service provision as well as access to help varies widely across the country, and practices need to work with what is available locally. Some of the solutions that Wessex area practices have developed include:

  • A nominated practice lead for carers, known to patients
  • A ‘Focus on carers’ pack, available to all carers
  • Email and telephone links to a local carers’ help group,for the use of both practice and patients
  • Carers’ support officer to look after carers’ needs, based in the practice as part of the health and social care team.

Staff employment policies – Management 10

GPs are essentially small employers, and they may be tempted to think that policies on equal opportunities, bullying, harassment and sickness absence are not relevant to them. However, this is not the case.

If your practice has a procedures manual covering staff employment policies and abides by the procedures it sets down,you are unlikely to have any problems, and if problems do occur it is much easier to defend your position.

If the practice does not have a procedures manual, or has one but does not abide by it, the consequences, both financial and in terms of time spent trying to resolve a problem, can be enormous.


Make the new contract work for your practice by taking time to review the practice management section of the QOF. If there are areas that you have found of little use, perhaps, for example, the indicator relating to carers, raise this with your PCO. It may be that another practice has implemented a procedure that has proved useful and is prepared to share their experience with you.


  1. Investing in General Practice:The New General Medical Services Contract. Supporting documentation, 2003. www.bma.org.uk
  2. www.victoria-climbie-inquiry.org.uk/
  3. www.healthandsafety.co.uk/haswa.htm
  4. www.iq-notforprofitmanager.co.uk/product.html#4

Guidelines in Practice, September 2005, Volume 8(9)
© 2005 MGP Ltd
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