Parts of QOF will be suspended and income-protected until April to free up GP capacity for delivery of the expanded Covid booster programme, NHS England has announced.
However, QOF indicators covering vaccination, cervical screening, register indicators and those related to optimal prescribing will continue to be paid on the basis of practice performance, it said.
NHS England also said that while PCN incentives around flu immunisation and appointment recording will be paid as normal, the remaining indicators in the network incentive scheme will be ‘suspended and funding repurposed’ until April.
In a letter sent to practices today, NHS England also set out a range of other measures to create ‘capacity’ in primary care:
- Income protection for the Minor Surgery DES from 1 December until 31 March 2022 for practices participating in the vaccination programme, with monthly payments to be made matching the corresponding period in Dec 2018 to March 2019. No contract enforcement where ‘no activity is done’ under the Minor Surgery Additional Service during the same period, but any capacity released ‘must be redeployed to vaccination’
- Routine health checks for over-75s and new patients may be ‘deferred’ from 1 December until 31 March ‘where contractors consider it clinically appropriate’
- An amendment to the Dispensing Services Quality Scheme reducing the requirement for medication reviews from a minimum of 10% of dispensing patients to 7.5% for 2021/22 – with practices asked to ‘prioritise’ patients considered ‘higher-risk’ or most likely to benefit from a review
- The CQC has ‘confirmed that routine inspections of practices will continue to be paused’ and only risk-based assessments undertaken, where ‘deemed critical to safety and quality’
The letter said: ‘The evidence-based care provided via QOF continues to be important in minimising health inequalities, securing the best outcomes for those with long-term conditions and preventing wider system impacts.’
But some changes will be introduced for 2021/22 ‘in order to support the ongoing response to Covid-19 and the increase in vaccination capacity, combined with the need to target proactively and support our most vulnerable patients during this period’, it added.
It said: ‘Some QOF indicators will continue to be paid on the basis of practice performance. These include vaccination, cervical screening, register indicators and those related to optimal prescribing.
‘Others will be subject to income protection based upon historical practice performance, in a similar way to arrangements in 2020/21.’
It added: ‘To be eligible for income protection, practices will need to agree with their commissioner a plan that will set out how QOF care will be delivered wherever possible but with priority according to clinical risk, and accounting for inequalities.’
Normal QOF arrangements will ‘recommence in April 2022’, it said.
NHS England also set out a part suspension of the PCN investment and impact fund (IIF), which will also restart in April.
Indicators introduced in April 2021 covering flu immunisation and the ‘completed work on appointment recording and categorisation will be paid as normal’, while the remaining indicators will be ‘suspended and the funding repurposed’, it said.
It added: ‘The majority of the funding allocated to these suspended indicators will instead be allocated to PCNs via a PCN Support Payment, on a weighted patient basis, subject to confirmation from the PCN that it will be reinvested into services or workforce.
‘The remaining funding will instead be allocated to a new IIF incentive to support PCNs whose practices are fully participating in the vaccination programme. Further details will follow.’
The letter said the measures have been put in place ‘given the invaluable contribution and scale of effort required in primary care’ and will ‘allow wherever possible practices and PCNs to continue to pursue the clinical ambitions underlying QOF and IIF while releasing capacity to support the increased vaccine effort’.
It added: ‘We recognise the pressure all local services are under, however as the Secretary of State for Health and Social Care has said, the “new national mission” is to increase vaccine capacity.
‘There are no supply challenges with either the Moderna or Pfizer booster stocks, therefore all vaccination sites are now asked to load their NBS calendars to the end of January, where possible.’
Meanwhile, the letter also expanded on the increased ‘financial support’ in the form of raised vaccination fees announced earlier this week to help ‘sites attract and retain staff, including during unsociable parts of the week’.
PCN vaccination sites can claim:
- An item of service (IoS) fee of £15 per jab administered Monday-Saturday from 1 December to 31 January (excluding bank holidays)
- A £20 IoS fee per jab given on Sundays or bank holidays over the same period
- A £30 supplement for third doses and booster jabs for housebound patients until 31 December, backdated for those already carried out
- A temporary £10 supplement Covid jabs administered to severely immunosuppressed people from 1 December to 31 January
- An ‘enhanced payment’ to support clinical director and management leadership of PCN sites to 1 WTE for the period 1 December to the end of March 2022
NHS England has reopened sign-ups for the phase three GP Covid vaccination enhanced service and any practices wishing to join the programme should ‘liaise with their local commissioner as soon as possible to discuss next steps’, it said.
And there is ‘some opportunity’ for PCN-led sites to be onboarded to the national booking system (NBS) where there is a ‘strategic need’, although onboarded sites should use the system for the ‘majority’ of their bookings’, it added.
The NBS, Patient Group Directive (PGD), National Protocol and Green Book are being updated to reflect the shortened three-month interval between second doses and boosters ‘as soon as possible and no later than 13 December’, but existing booking arrangements remain in place in the meantime, NHS England said.
It confirmed that ‘no immediate action is required’ regarding new JCVI advice on second Covid vaccine doses for 12-15s but said it would ‘write separately on implementation of this advice’.
The BMA welcomed the support measures, saying that they ‘begin to recognise’ that GPs ‘cannot do everything for everyone all of the time’ due to the ‘finite number’ of staff and hours in the day.
BMA GP Committee England chair Dr Farah Jameel said: ‘We hope that, by removing some of the more bureaucratic and target-based requirements within practices’ contracts, staff time can be freed up to get more jabs into arms, while allowing practices to focus on patients who need their attention the most.
‘Patients need to know that if they are unwell or have concerning symptoms and need to receive care from their practice they will continue to be prioritised and GP teams will continue doing their very best to keep their sickest patients safe in every way they can and know how.’