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Audit Commission - Patients and taxpayers may be losing out in GP incentive scheme

A government scheme that incentivises general practitioners (GPs) to improve their services to patients may not be having the impact it should because of poor oversight of the payments being made, the Audit Commission has found.

The Department of Health introduced the Quality and Outcomes Framework (QOF) in 2004 as part of a new contract for GPs. GPs are awarded points for their achievements against different criteria, such as the number of patients given a certain treatment. Those points are then translated into financial rewards. Primary care trusts (PCTs) are responsible for ensuring payments are properly made.

The report, Paying GPs to Improve Quality, finds the best PCTs carefully check the administration of QOF claims, arranging annual visits to GP practices by a suitably trained GP to examine evidence and produce good quality reports. These trusts have a clear idea of the impact on patients and whether the payments are being properly and fairly made.

Areas of weakness in other trusts fall into two areas: probity and value for money. Some cannot be confident that payments made to GP practices are correct and justified, or delivering good value. And some patients may not be getting the services they should be.

One of the main areas of inconsistency across the country is exceptions, whereby GPs can exclude certain patients from their returns for payment. Exceptions can be made for patients who refuse to attend reviews when invited, or where a 'good practice' medicine can't be prescribed for medical reasons.

But the report finds a wide variation in the exception levels between different PCTs ranging from 3.81 to 7.65 per cent of patients. Within PCTs, exception levels in individual practices vary even more, with one PCT included in the study showing exception rates ranging from 2.5 to 15.1 per cent. Exception rates for individual treatments or activities related to individual diseases can be much higher.

Some variation can be expected, because of geography for example. But the report states that PCTs must take suitable action to ensure patients are only exception-reported for legitimate reasons. Otherwise, some patients will not be receiving the treatment and care that they need.

Andy McKeon, Managing Director of Health at the Audit Commission, said:
'Audit isn't just about counting the pennies, it's about ensuring that patients get the services they are entitled to and that taxpayers' money is spent in the best possible way. Our report shows a wide variation in how PCTs approach this, ranging from poor to good. The best can be confident that they are spending the money well, GPs are getting the rewards they deserve and patients are getting the services they need.

'But in some areas that isn't the case and patients may be missing out because of poor administration of the scheme. PCTs will soon give way to the new NHS Commissioning Board and GP consortia. Robust audit will be crucial to ensure the payments are being properly and fairly made under any incentive schemes and patients get the benefits intended.'


Notes to editors

  1. In carrying out this review, researchers collated the findings of external auditors who had carried out work at 12 PCTs, and spoke directly to three PCTs.
  2. The Audit Commission is an independent watchdog, driving economy, efficiency and effectiveness in local public services to deliver better outcomes for everyone.
  3. Our work across local government, health, housing, community safety and fire and rescue services means that we have a unique perspective. We promote value for money for taxpayers.
  4. On 13 August 2010 the Secretary of State for Communities and Local Government announced that he plans to disband the Audit Commission. His intention is to have new arrangements in place for auditing England's public bodies by 2012/13.

For further information please contact:
Louise Neilan, Media Relations Manager
Tel: 020 7166 2132
Mob: 07766 697 801
Email :

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