A roundup and analysis of latest measures set out by NHS England to support GPs administer the Covid booster jabs to all adults over 18
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 warned that QOF and IIF payments may be made ‘later than usual’ for 2021/22 ‘given that the proposed changes to the scheme are being made towards the end of the year’.
In addition, 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 letters sent to GPs last week and this week, NHS England also set out a range of 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 2022 ‘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.
Latest announcement on QOF, includes:
- GPs should focus on the four QOF vaccination and immunisation indicators, the two cervical screening indicators, the register indicators and the eight prescribing indicators, which will be paid based on practice performance.
- 46 QOF points for new indicators where there is no historic performance to use as the basis for income protection will be reallocated to increase the total points available for the eight prescribing indicators.
- The remaining indicators will be income protected using a methodology very similar to the one applied in 2020/21.
- To be eligible for income protection, practices will need to agree with their commissioner a plan that sets out how QOF care will be delivered wherever possible but with priority according to clinical risk, and accounting for inequalities.
- Normal QOF arrangements will restart in April 2022.
What does the latest announcement mean for practices in terms of QOF?
Dr Gavin Jamie, a GP in Swindon who also runs the QOF Database website, said it continues to be worthwhile for practices to maintain their disease register
‘The registers remain active so the preserved points will be adjusted for current prevalence. In some cases, these disease registers do not have an indicator of their own (depression and non diabetic hyperglycaemia), but the numbers will still need to be kept up in order to maximise the value of the points.’
Further details included in the letter included information about:
The PCN investment and impact fund (IIF):
- Indicators introduced in April 2021 covering three flu immunisation indicators 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’.
- Funding allocated to these suspended indicators will instead be given to PCNs via a £62.4m PCN Support Payment, on a weighted patient basis, subject to confirmation from the PCN that it will be reinvested into services or workforce.
- £49.7m will be allocated to a new ‘binary’ indicator paid on the basis of participation in the Covid booster programme.
- IIF will restart in April.
Payments that PCN-led 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 for Covid jabs administered to severely immunosuppressed people from 1 December to 31 January 2022.
- 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.