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03-07-2011 | General practice | Article

Non-QOF care ‘neglected’


BMJ 2011; 342: d3590

Care activities that do not earn points under the Quality and Outcomes Framework (QOF) may have been neglected as a result of GPs focusing on care with financial incentives, research suggests.

The study, published in the BMJ, found that achievement of 22 out of 23 QOF care indicators improved sharply in the year after QOF was introduced, with standards maintained since. By contrast, achievement of certain non-incentivised care indicators remained static initially, before slumping in subsequent years.

Researchers used the General Practice Research Database (GPRD) to analyse trends in quality of care in 500 UK general practices, before and after the introduction of QOF in 2004.

The results showed that in 2004-5 achievement rates increased markedly beyond projected trend for all 17 QOF measurement indicators, and for five out of six prescribing indicators. Those for four indicators, all related to smoking, increased by over 30% more than expected.

Overall, rates of achievement for both these groups reached a plateau by 2006-7, but were still significantly higher than projected trends.

"Most practices attained achievement rates above the maximum achievement thresholds… for most incentivised indicators in the first year, and thereafter had no financial incentive for further improvement," note the study authors, led by Dr Tim Doran from the University of Manchester.

Although there was little overall impact on achievement rates for non-incentivised indicators in the first year after QOF was introduced, by the third year achievement had fallen below predicted rates. Thus, incentives "seem to have had some detrimental effects in the longer term, possibly because of practices focusing on patients for whom rewards applies", the authors write.

Dr Doran and team say their findings highlight "important limitations of financial incentive schemes in health care", and call for non-incentivised care to be monitored in order to assess the full impact of such schemes.

GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Caroline Price