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Independents' Day

Call for QOF admissions targets

By Lilian Anekwe

GPs should be judged on their ability to reduce hospital admissions as part of a series of downstream outcome targets set in a revised QOF, a new report recommends.

The authors are also calling for the number of indicators in the QOF to be cut as part of the process of securing greater value for money.

The review of the QOF by social policy think-tank Civitas comes at a critical time, with NICE undertaking a review and determined to set a new batch of outcomes indicators.

The review concluded that the QOF should shrink both in size – with cost-ineffective indicators removed – and as a proportion of overall GP income.

Future indicators should only be included if they were cost-effective and could demonstrate health outcomes – including reductions in hospital admissions.

The authors combined a comprehensive review of literature on the QOF, with structured interviews with GPs, academics and representatives from the BMA and the RCGP.

The report concluded: ‘The QOF does not attempt to measure whether the problems that patients are experiencing are actually improved as a result of the interventions of general practice and whether QOF interventions have worked.

‘One proxy measure might be the number of avoidable admissions to hospital. In encouraging better management of chronic conditions, one would expect the QOF to lead indirectly to fewer patients presenting at A&E with symptoms generally considered "avoidable", such as hypoglycaemic coma.'

Professor Helen Lester, professor of primary care at the National Primary Care Research and Development Centre, said a move to introduce outcomes measures into the QOF would only work if intermediate outcome measures were used.

‘A shift to pure outcomes does not make sense. But I think there is an argument for a mix of process and intermediate outcomes. The problem with pure outcome measures like mortality is there are so many other things that influence mortality, that may not be within a GP's control.'

The report added: ‘The number of indicators in the QOF should be cut and – while open to new evidence – confined to clinical indicators, such as ACE inhibitors in heart failure or influenza immunisations in over 65s, which have been rigorously proven to deliver significant, cost-effective, health gain to many.'

GPC chair Dr Laurence Buckman, said: 'The QOF is one government target that has brought real benefit to patients across the UK. It is very disappointing that this document is short on evidence and long on opinion about one aspect of the GP contract that has brought real benefit to patients.'

Recommendations for the QOF

• Should be downscaled, both in terms of the number of indicators and in terms of the proportion of income it represents for general practice
• The proportion of income it is possible to derive from the QOF should be reduced to the seven per cent suggested by QOF architect Professor Martin Marshall
• The number of indicators should be cut and limited to those that deliver significant, cost-effective, health gains
• An extended analysis of the actual health gains from indicators should be conducted by NICE, but overseen by the profession
Source: Checking up on doctors: A review of the QOF for GPs, James Gubb * Grace Li, Civitas

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