Back in June 2014 more than two thirds of GP practices in Somerset ditched QOF for an alternative regional scheme that is regarded by NHS England as an early pilot of co-commissioning arrangements.

The Somerset Practice Quality Scheme (SPQS), run by NHS Somerset CCG, has been touted as the potential replacement for QOF across the country. Now, nine months after its introduction, GP leaders involved in the scheme have commented that it has maintained a high quality of patient care whilst ditching reporting.

Provisional findings from an independent evaluation of the scheme and the impact on general practice say the scheme is reassuring, potentially paving the way for CCGs to drop QOF as part of co-commissioning, based on the Somerset model.

Reporting a thing of the past

The SPQS allows practices to stop reporting in all but a small set of core clinical QOF indicators. Instead, regular reports are presented to the area team, outlining how the released funding has been used to improve local services. Practices participating in the scheme will work with other health organisations in Somerset to share staff between practices and provide more advanced care of long-term conditions and in the care of the frail and elderly. Funding meanwhile is equivalent to QOF levels and payment is essentially based on a small selection of indicators that provide an ‘at a glance’ measure of quality.

Examples of the SPQS work include:

• Three small practices in West Somerset are working together to provide enhanced end of life care at home for people in very remote rural communities. The nearest acute hospital is an hour away even by ambulance. A nurse has been employed to provide proactive, comprehensive care and works extremely closely with the GPs.
• Taunton Deane Federation of GPs is organising multi-disciplinary, multi-agency review meetings for patients with multiple long-term conditions who are frequent users of health services. The aim is to review their care and ensure that they are supported to manage their own health.
• Practices in Chard, Ilminster and Crewkerne are working closely together to develop a model of a shared nursing team between the practices.

Focus on practice nurses

With SPQS all about focusing on patient care, practice nurses are predicted to benefit. Dr Matthew Dolman, chairman of Somerset Clinical Commissioning Group, said: “I think having listened to what the practices want will allow practice nurses to work in a much more efficient, effective way that is person-centred, not computer list-generated. I think practice nurses are doing a significant amount of patient centred care, but we need to create more time and training for them.

“One of the key outcomes we are aiming for is to recruit more nurses in practices and keep them there.”

Not all positive

While the initial assessment of SPQS is a strong one and GPs claim they have been ‘liberated from box ticking’, not everybody is so positive.

Some practice managers say that local schemes lack national protection which could leave GPs out on a limb, especially over time as the various local schemes diverge. Others say that the power of national negotiation will be lost, while some worry about the loss of the QOF guidelines, which made GP partners aware of what was required of them and encouraged adherence.

Meanwhile, at the launch of SPQS, the British Medical Association has warned that allowing GPs in a single clinical commissioning group to break away from the nationally agreed quality and outcomes framework could lead to the “Balkanisation of national healthcare”.

Divided opinions

The ‘local QOF’ idea seems to be dividing opinions, highlighted by news reports suggesting that just half of GPs are in favour. Meanwhile, over a dozen CCGs are said to be looking into their own versions of the SPQS. In fact, some CCGs are well on the road towards their own local set-up and new co-commissioning models could open the door to easier introduction, meaning it’s an issue that’s not going to go away.

We would love to know what you think about the SPQS idea. Are you in favour? What do you think it would mean for your practice? Comment below or head to the forum.