The Taskforce’s for Lung Health Submits Response to the Consultation on Primary Care Incentives

8 March 2024

The Taskforce has submitted a response to the Government’s consultation, which poses the question of whether the Quality and Outcome Framework (QOF) should continue to form part of GP income. Our response highlights that incentives for practices must prompt improvements in care for patients in the most deprived communities and ensure that people with respiratory conditions are properly supported to manage their conditions.

Our ‘Saving your Breath, report found there is a significant north-south divide in respiratory outcomes in England, with deprived communities accounting for three times the number of winter admissions for asthma and four times the number of winter admissions for Chronic Obstructive Pulmonary Disease (COPD). Given these stark inequalities, our response calls on to Government to widen the scope of this discussion to capture regional disparities and the prevailing issues in the healthcare workforce.

The Taskforce’s submission details our members’ concerns that QOF is perceived as a tick-box exercise with practices now relying on QOF for baseline funding. We worry that QOF has shifted from a bonus to baseline income, as on average it now generates 8.5% of practices’ income.

Practices in the most deprived areas averaged the lowest number of QOF points, and those in the most affluent areas scored the highest. This means that practices that serve the poorest communities are missing out on this income from QOF, further exacerbating health inequalities. This is why in our response we argue that the Government must increase practices baseline income if it wants to tackle health inequalities.

Our submission argues that QOF currently is not effective in incentivising improving care and outcomes for people with respiratory conditions. We know that Pulmonary (PR) is one of the most cost-effective interventions for people with COPD, with 90% of those who completed a course reporting higher activity and improved quality of life. QOF targets require 90% of patients with COPD to be offered a referral for pulmonary rehabilitation (PR). Despite the effectiveness of PR, the referral rate is only 13.8% of the diagnosed COPD population. Furthermore, once referred many patients will just sit on a waiting list, with the completion rate only being 31% of the referral population.

To improve the care of long-term conditions and expand access to PR services for all COPD patients the Government must set ICB-level incentives. In our response, we advocate for the alignment of incentives for the management of long-term conditions over primary, secondary, and tertiary care as ultimately, we believe this will improve the care of people with chronic lung disease.

Additionally, our response points to members’ criticism that QOF currently limits GP’s ability to tailor care to local communities. Our response highlights how local QOF alternatives in Somerset have improved the care of people with long-term conditions, and reduced A+E admissions and mortality. We believe that ICBs should be able to select priorities from a national menu, to allow incentives to be adapted to the socioeconomic and epidemiological attributes of the populations that practices serve.

Lung conditions are the third largest killer with the biggest impact on health inequalities. Therefore, our submission cautions that if a flexible QOF is introduced across England respiratory health must be a cornerstone of care in all ICBs.

Please contact us if you have any questions about our submission.