Quality and Outcomes Framework: what have we learnt?BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4060 (Published 04 August 2016) Cite this as: BMJ 2016;354:i4060
All rapid responses
I agree with the statement that QOF initially reduced inequalities in delivery of care between practices in deprived and affluent areas for some major chronic diseases. There is good evidence for this. However, more recently it has been suggested that there is little evidence that QOF itself has had any direct impact on reducing inequality between population groups in terms of health outcomes .
At a time when the future of QOF in England is uncertain, it seems prudent to think how future iterations of QOF (or a similar payment-for-performance scheme) could do more to directly reduce health inequality. As mentioned by Steel and Shekelle in the editorial accompanying this analysis , this could be part of a shift towards focusing less on healthcare as the main determinant of good health.
The Greater Manchester Combined Authority now cares for its own £6bn budget . In this group, health and social care services are aligned with other parts of the public sector such as education and housing. Such initiatives may provide an opportunity to improve population-level health as part of a multi-sectoral payment-for-performance scheme. This might aid overwhelmed GPs, giving them more time to focus on the patients they see every day. However, it is recognised that this may bring its own unique problems, such as who receives the payments. The movement towards joined-up primary care, federations and super-partnerships may also facilitate QOF to be approached more efficiently.
I have written a longer piece on this topic area which I welcome those interested to read. It also covers other ways QOF could do more to tackle health inequality. It is available online (http://dx.doi.org/10.1080/17571472.2016.1215370) and will be published in the Sept/Oct edition of the London Journal of Primary Care.
1 - Dixon A, Khachatryan A, Wallace A, et al. Impact of quality and outcomes framework on health inequalities. The King’s Fund. 2011. ISBN: 9781857176186.
2 - Steel N, Shekelle P. After 12 years, where next for QOF?. BMJ;354:i4103.
3 - Greater Manchester Health and Social Care. Devolution: what it means. [cited 2016 Mar 12]. Available from: http://www.gmhsc.org.uk/devolution-what-it-means/
Competing interests: No competing interests
Heaven help us all, if ‘Old man. Want NHS money to be spent wisely’ counts as a Competing Interest (response by JK Anand, 6 August). Competing against what ?
Although – just possibly, and very disturbingly – perhaps I should have written ‘when’ and not ‘if’.
Competing interests: No competing interests
I am grateful to Prof Roland and Prof Guthrie for the skillful dissection of this ill-conceived teratoma.
Suggestions: Abolish it.
Give the money to the GPs for treating patients in front of them according to their clinical
Competing interests: Old man. Want NHS money to be spent wisely
Comment on BMJ paper on QoF
I read this paper with interest and some disquiet as a patient as the theme seems to be based more on feasability, herd disease incidence and, as always, money as shown below:
• Percentage of patients aged ≥45 who have a record of blood pressure in the preceding five years
• Percentage of patients with coronary heart disease in whom the last blood pressure reading (measured in the preceding 12 months)
is ≤150/90 mm Hg
• Percentage of diabetic patients with up-to-date influenza immunisation
A search for “efficacy” was entirely negative but surely the whole purpose of medicine is to improve health of individual patients. In particular as an individual patient, my concern relates to the benefits of taking a particular medication and indeed any adverse reactions that I suffer. To be told that drug X does not “cause Y” when “Y” is specifically listed in the data insert does nothing to impress. Also to be told that “Y” is rare merely annoys when one has suffered “Y”; for the individual its incidence is 100%. A search of the report revealed the following single instance of “adverse”:
It would therefore be prudent to require some limited ongoing data collection to avoid serious adverse consequences of withdrawing financial incentives.
The impression that I get regarding QOF is that it is merely an administrative tool for keeping tabs on GPs in relation to their keeping to the health Directives (aka guidelines - so-called to protect the authors). Certainly what comes across is that it is NOT designed with individual patient health in mind. As Dr Spence commented some years ago in the BMJ, QOF is an expensive disaster and more recently on EBM (http://www.bmj.com/content/348/bmj.g22?sso=) to which presumably QOF is supposed to contribute
Then one hears that GPs are leaving or retiring from the service and young doctors are not interested in becoming GPs. Frankly I would not become a GP when I look at the way they are treated like a bunch of children. The medical establishment is simply concerned with money and their statistics for administrative and political reasons.
May I point out that as a patient the people on whom I depend to keep me alive and well are my GP, practice nurses, Nurse-led clinics and the docs and nurses in the local hospital. I do not depend on possibly conflicted researchers in the medical establishment and their data analyses relating to the “HERD”
Competing interests: As a very irate patient