By Lucy Phillips
3 February 2011
Poor oversight of an incentive scheme for GPs could be
affecting patient care and attempts to get value for money, auditors have said.
In a report published today, the Audit Commission found a
wide variation in the way English primary care trusts monitored the Quality and
Outcomes Framework, a scheme introduced in 2004 to financially reward GPs for
improving aspects of their work.
Around £1bn is paid out each year by PCTs to more than 8,300
GP practices under the scheme.
The report, PayingGPs to improve quality, found some trusts could not be sure the payments
they made were correct and justified, or provide good value for money. Some
patients might also be losing out.
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.’
One of the main areas of inconsistency was when it came to
the reporting of ‘exceptions’. GPs can exclude certain patients from their
returns for payment if, for example, they refuse to attend reviews when invited
or where a ‘good practice’ medicine cannot be prescribed for medical reasons.
But levels of patients that were ‘excepted’ ranged from
3.81% to 7.65% across the country and within PCTs from 2.5% to 15.1%, prompting
the watchdog to urge the trusts to ensure GPs were only reporting exceptions
for legitimate reasons.
Under the government’s health reforms, PCTs will be replaced
by a new NHS Commissioning Board and GP consortiums.
McKeon added that robust audit would be critical in the new