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    RCGP calls for an end to the ‘vicious cycle’ of unfair funding for GP training

    Tuesday, 10 July 2018 09:39
  • GMS ready reckoner published

    GMS ready reckoner published

    Wednesday, 04 July 2018 15:22
  • Scotland update Golden Hello arrangements for GPs

    Scotland update Golden Hello arrangements for GPs

    Friday, 29 June 2018 15:11
  • Extra £20m funding will go hand-in-hand with a new 10-year plan for the NHS

    Extra £20m funding will go hand-in-hand with a new 10-year plan for the NHS

    Monday, 18 June 2018 17:31

QOF-buttonMarch 11 2015

The Quality and Outcomes Framework “does not seem to result in reduced incidence of premature death in the population,” a new study has concluded.

Data from the study suggests that death mortality rates in England decreased by 14% between the third and eighth years of the QOF, since being introduced in 2004. However, the researchers “could not identify a relationship between practice performance on the clinical aspect of the QOF and mortality outcomes in the practice locality.”

The QOF is “a national primary care pay-for-performance programme” which has cost approximately £1 billion each year since 2004. The analysis was carried out by a team based at the University of Manchester. It had conducted the longitudinal spatial study with the aim of quantifying the relationship between the QOF and all-cause and cause-specific premature mortality linked closely with conditions included in the framework.

It took data from the 8,647 general practices in England participating in the QOF for at least one year, representing over 99% of patients registered in primary care. The main outcome measures were all-cause and cause-specific mortality rates for six chronic conditions: diabetes, heart failure, hypertension, ischaemic heart disease, stroke, and chronic kidney disease.

The North East and North West regions had the highest median all-cause death and standardised mortality rates (SMRs), say the authors. “Crude condition-specific death rates were more uniform across England, with the exception of London and its younger population, where rates were 33% below the national average in 2010-11.

“We found that overall quality of care provided by practices—as measured by achievement across all clinical QOF indicators—was not associated with mortality rates in their localities for conditions covered by the QOF. There remained no association when potential effects were lagged for up to three years.”

Responding to the study, Dr Chaand Nagpaul, BMA GP committee chair, said: “The QOF was never intended to be judged or analysed on the number of premature deaths in certain disease areas, not least as death rates are affected by numerous factors, including levels of social deprivation.

“What the QOF was designed to do was to target resources and care to patients with certain long-term conditions, such as diabetes, heart disease and dementia. It is based on the best available independent clinical evidence and has led to a substantial improvement in the detection and treatment of these conditions. This has improved the lives of tens of thousands of patients across the UK.

“The funding linked to the QOF goes into GP practice overall funding for them to spend on patient services, practice staff and the facilities used by patients. The funding linked to the QOF is not an added extra but an essential component of GP practice funding without which practices would not be able to employ the practice nurses, GPs and other support staff that they currently do.”

Links:

‘Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study’. Evangelos Kontopantelis et al. BMJ 2015;350:h904    

BMA response    

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