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Health and Social Care Bill

moved Amendment No. 70: 70: After Clause 134, insert the following new Clause— ““GMS contracts: payments (1) Section 87 of the National Health Service Act 2006 (c. 41) (GMS contracts: payments) is amended as follows. (2) For subsection (4) substitute— ““(4) Before giving a direction under subsection (1), the Secretary of State— (a) must consult any body appearing to him to be representative of persons to whose remuneration the direction would relate; (b) must have regard to any advice given to him by the relevant advisory body; and (c) may consult such other persons as he considers appropriate.”” (3) After subsection (4) insert— ““(4A) In this section, the relevant advisory body means a body of persons to be called the Quality and Outcomes Framework Review Panel (referred to in this Act as ““the Review Panel””) to perform the functions assigned to the Review Panel by or under this Act. (4B) The Review Panel shall give to the Secretary of State advice on matters relating to directions made under subsection (1).”””” The noble Earl said: My Lords, this amendment is about the quality and outcomes framework—QOF—which is a voluntary annual reward and incentive scheme introduced as part of the new GP contract in April 2004. In 2007-08 under the scheme, GPs were awarded 1,000 achievement points for managing common chronic conditions, how well the practice is organised, how patients view the care that they receive and the amount of extra services that are offered. When the new GP contract was introduced, it was agreed that the QOF would be subject to ongoing review and development to ensure that it accurately reflected changing clinical practice and new therapeutic areas. It was agreed that an independent expert group would consider the latest available evidence and make recommendations to the four health departments of the UK and that it would then be up to the negotiating parties to agree any changes to the quality framework. Since the GP contract came into force, the QOF has been renegotiated twice: once for the 2006-07 contract and once for the 2008-09 contract. Each renegotiation has involved a robust, evidence-based process. For example, in 2006-07, the QOF renegotiation was informed by a review panel comprising the University of Birmingham, the Society for Academic Primary Care and the Royal College of General Practitioners. Following the receipt of 514 submissions, the review panel made recommendations to NHS Employers and the GPC. During the negotiations between the GPC and NHS Employers, the review panel was available to clarify questions of evidence for the negotiating parties. The 2006-07 renegotiation resulted in a number of small but significant changes; for example, 15 new evidence-based indicators in seven new clinical areas were introduced. This was not in any way a cursory process. The success of those negotiations laid the foundations for the review panel to be placed on a more formal footing. In August 2006, the University of Birmingham was awarded a three-year contract to inform the ongoing review and development of the QOF. A new review panel was constituted, comprising over 40 senior academics who were expert in the field of general practice. The cost to the taxpayer of this three-year contract was nearly £800,000, excluding VAT. The review panel began its work reviewing the QOF for 2008-09 after receiving 153 completed questionnaires from national societies, patient groups, individuals, pharmaceutical companies, primary care organisations and others. The review panel considered the written questionnaires and then held oral evidence sessions with a number of the groups that had submitted evidence. The QOF negotiations then commenced, informed by the findings of the panel. We know from the BMA that the recommendations submitted by the review panel included two new clinical areas with respect to the management of osteoporosis and peripheral arterial disease, an expansion of the scope of ethnicity monitoring, a new indicator in the area of heart failure and enhancing the points value in the QOF of chronic kidney disease. What happened? The recommendations of the expert panel, prepared at great trouble and not inconsiderable expense, were effectively overturned. In their place, the GPC was presented with a Hobson’s choice, the effect of which was the hijacking of the QOF by a set of objectives that owed more to the pledges made by the Prime Minister during his campaign for the leadership of the Labour Party than they did to clinical need. The focus was suddenly on supporting improved access to GPs and, in the final agreement, no points at all were allocated to support the areas recommended by the expert panel. In ignoring the detailed conclusions of the review panel, the Government drew a large amount of criticism from professional and patient groups. Dr Laurence Buckman of the GPC called the Government’s plans, "““incredibly short-sighted and ill thought out. It seems the Government has scant regard for older and chronically ill patients””." A letter published in the Times on 14 January 2008 and signed by, among others, the British Society for Rheumatology, the Royal College of Nursing, the British Orthopaedic Association, Help the Aged, the British Geriatrics Society, the Royal College of Surgeons and the National Osteoporosis Society, stated that many osteoporotic fractures, "““could he prevented if patients had an early diagnosis and were put on treatment to strengthen their bones. The new measures proposed for the GPs’ contract would have constituted one of the most beneficial and cost-effective reforms in patient care for older people in recent years””." The letter said: "““It is therefore particularly regrettable that the Government has not accepted proposals in the new GPs’ contract that would have benefited millions of older people at risk of osteoporosis and life-threatening fractures””." The good will of those organisations and individuals who took time to make submissions to the QOF review has been sorely tested. Without some way of ensuring that evidence-based recommendations made by the expert panel are guaranteed some standing in the QOF review process, it is doubtful whether public and professional involvement in attempting to formulate sensible proposals can be maintained at the level that we have seen. The rationale for the amendment is therefore to ensure that the recommendations of the review panel cannot simply be ignored. This is not just my own idea. The National Audit Office, in its report of 28 February, NHS Pay Modernisation: New Contracts for General Practice Services in England, said that, "““the Department should develop a long-term strategy to support yearly negotiations on the QOF and develop the QOF based on patient needs and in a transparent way””." I am aware that the noble Lord, Lord Darzi, is considering the QOF as part of his next-stage review. I very much hope that he will understand what has prompted me to raise these matters and why I believe that they merit the closest attention. I hope that the noble Baroness will be able to indicate in her reply that, if the QOF is to work as originally intended, we simply cannot have a repeat of what happened this year and that safeguards of the kind that I am proposing are in everyone’s interests. I beg to move.