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Care boost not at expense of areas left out of contract

Study challenges doubts over QOF

By Ingrid Torjesen

The debate over the impact of the GP contract on patient care has taken a fresh twist with a study suggesting it has boosted efforts overall rather than just shifting areas of focus.

Researchers found a significant increase in prescribing of drugs in areas incentivised under the QOF – but no comparable decrease in areas that do not carry points.

The research will come as a boost to the GPC as it aims to use the benefits of the QOF as ammunition in fighting the Government's attempts to put a freeze on GP pay.

It has emerged GPC chair Dr Hamish Meldrum plans to meet QOF architect Professor Martin Roland to discuss how to make a case for the benefits of the QOF.

The new Scottish study, presented at a Drug Utilisation Research Group conference in London last week, found

prescribing of drugs for QOF conditions rose in the two years before and after introduction of the contract, by up to 1.2 per cent per month.

Drug use increased particularly quickly in the year before the contract, indicating GPs were readying themselves for the new indicators.

But there was no fall in rates of prescribing for other drugs listed in the first 10 chapters of the BNF, easing fears that the QOF was distorting clinical priorities. A recent study reported a fall in GP consultations for conditions not in the QOF.

Study leader Sean MacBride-Stewart, primary care pharmacist at NHS Lothian in Edinburgh, said there had been an increase in prescribing for a range of drugs, particularly statins and antihypertensives: 'My gut feeling is that the prescription of QOF drugs has increased all over Scotland.'

But he added: 'I can't say there has or hasn't been any detriment to non-incentivised areas – only that there has been no decline in prescribing.'

Dr Richard Cookson, senior lecturer in health policy at the University of York and a researcher on the likely health impact of QOF indicators, said the study did not preclude the possibility of other forms of skewing of care. 'The things you would really expect to suffer are soft things you can't measure, such as spending time with the patient to diagnose conditions.'

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