QOF & CPI Issues – Response from NHS England
The QOF re-calculation highlighted last week is expected to result in approximately a 1.95% increase in QOF 13/14 achievement on CQRS for most GP practices. Further information about the re-calculation of QOF 2013/14 achievement and declaring achievement can be found in these FAQs. NHS England has also responded to some of the queries in relation to this as outlined below:

Why is the index list size taken as it stood on 01 January 2013, when the year in question is 1 April 2013 to 31 March 2014?  Basing the actual national average practice list size on that at the start of the last quarter before the financial year in question ensures there is transparency going into the financial year.

On the whole, it appears that list sizes are increasing – why is the current list size not taken into account? Contractors current list size is reflected in the CPI calculation which is the sum of Contractors Registered Population (generally that at the start of the final quarter in the financial year) divided by the actual national average list size as above.

CPI allows QOF payments to reflect comparative list size.

Is the PMS QOF deduction also incorrectly based on the January 2014 CPI figure? The letter from NHS England to area teams sent on 4 April uses the average list size which is applicable for 2014/15, but the calculation is for the 2013/14 QOF. NHS England has provided the following briefing in response:

• The QOF PMS Points Deduction was set in 2004 as £13,050 for average PMS practice – that was a practice with a list size of 5,891 (the average in 2004). £2.22 is the deduction calculated as the price per patient when you divide the above price by the then average list size (£13,050/5891).
• The worked example in the letter has used an incorrect CPI figure, but it is just that a worked example, to demonstrate that the current CQRS calculation will undervalues the QOF PMS Points Deduction.
• The national average practice list size for use in CPI to calculate 2013/14 QOF achievement is being corrected to 1st January 2013, which is 6911, which is in line with the SFE. So to run the worked example again, a practice of 6,200 patients should have its deduction calculated as 6200/5891 x 13050 = £13,735 but CQRS will calculate as 13050 x 6200/6911 = £11,707. So CQRS remains to undervalue the deduction that needs to be made and in this example by £2,028.
• Another way of looking at is CQRS will calculate the deduction at £1.89 price per patient (£130505/6911) which is a difference of £0.33 price per patient (£2.22-£1.89). Using £0.33 might be a simpler basis to calculate the adjustment required.

14/15 QOF Point Value
During the QOF negotiations for 14/15, the GPC negotiating team highlighted the issue that the QOF point value needed to increase comparatively along with any increase in the national practice list size to NHS England. Although there was a 16% rise in the value of QOF points for 13/14, GPC pointed out that this would be an ongoing problem every year if QOF was not adjusted accordingly every year. It was argued that due to the 16% increase in QOF point value, this change was meant to be cost-neutral. It clearly has not been, so GPC are continuing to put pressure on NHS England to sort it out.

Technical Requirements Guidance for 14/15 Contract
This Guidance on the technical requirements and this guidance and audit requirements document for the GMS contract for 2014/15, includes information on clinical enhanced services, named GPs for patients over 75, and vaccinations and immunisation.

Guidance on PMS Reviews & Equitable Funding for PMS Practices
As part of the 2013-14 contract imposition, the government in England planned far-reaching changes to practice funding. From 1st April 2014, the wide variation in core funding per patient between practices will begin to reduce. This may have a profound effect on practice income. Practices with above average levels of funding generally receive either large correction factor payments (as a result of the Minimum Practice Income Guarantee (MPIG) negotiated at the time of the new general medical services (GMS) contract) or above average personal medical services (PMS) funding. NHS England’s guidance puts the amount of ‘premium’ expenditure, (identified as the amount by which PMS expenditure exceeds the equivalent items of GMS expenditure) at £325m, which will reduce to £235m over the seven years to 2021-22 as GMS correction factor funding is phased out and global sum funding increases. The guidance states that Area Teams should invest the premium funding according to the following criteria:

• reflect joint Area Team /CCG strategic plans for primary care
• secure services or outcomes that go beyond what is expected of core general practice or improve primary care premises
• help reduce health inequalities
• give equality of opportunity to all GP practices
• support fairer distribution of funding at a locality level

Area Teams will complete these reviews over a two year period starting in April 2014. NHS England has suggested that GP practices can expect LMCs to be engaged in the local review process. GPC guidance on PMS reviews and equitable funding for PMS practices is available along with NHS England’s letter to Area Teams and accompanying presentation.

CLMC has been contacted by a number of practices with a view to reinstating the PMS Group which represented practices during the PCT PMS review process. Once we have further details on how the Area Team will be progressing with the PMS Review locally we will contact practices to consider the best way to ensure PMS Practice views in Tees are represented.

Care.data Phased Roll Out
A six-month extension to the start of data collections from GP systems under the care.data initiative was announced in February. Representatives from the GPC and BMA have met regularly with NHS England to discuss the actions to be taken between now and the autumn.

The GPC is also represented on the recently established independent care.data advisory group. The purpose of the group is to make recommendations to the care.data programme board to help ensure the benefits of the programme are understood and articulated, as well as the risks, and that these risks are appropriately mitigated. NHS England has issued a letter to stakeholders, which confirms that care.data will now proceed in the autumn with a phased roll out of the GP data extraction process. This will involve a cohort of between 100 and 500 GP practices to trial, test, evaluate and refine the collection process ahead of a national roll out. Further information on how the phased roll out will be implemented will be available soon.

Steps are also being taken to make changes to the law that will further increase protections around confidentiality and ensure greater transparency around the release of data by the Health and Social Care Information Centre (HSCIC). The HSCIC will provide additional assurances over the safety of data collected, stored and shared, including the option of accessing data from a controlled environment, sometimes referred to as a ‘data-lab’ or ‘fume-cupboard’, for use by organisations requesting data. NHS England will be taking further action to ensure that patients have a clearer understanding of the care.data programme and will be working with stakeholders to produce additional supporting materials, such as a template letter for patients, as well as simplifying the opt-out process.

NHS England is keen to hear your views so that they can improve and build confidence in the programme. They will be engaging with GPs and patient groups through local and regional engagement events and they also welcome individual comments, which can be emailed to: england.cdo@nhs.net. We recommend you feedback your concerns and suggestions.

NHS Property Services Guide for Customers & Tenants
New guidance for tenants has been launched by NHSPS.