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QOF 'may have undermined care in children'

The introduction of the QOF in 2004 may have had the unintended negative consequence of worsening care and increasing hospital admissions for children, a study has found.

Research in the Annals of Family Medicine assessed the impact of the 2004 contract and identified an 8% increase in short-stay admissions among children with primary-care sensitive chronic conditions immediately after the contract’s introduction.

With fewer than 3% of QOF targets aimed at improving care for children the study notes it is  ‘particularly concerning’ that ‘admission rates among children with chronic conditions… are now surpassing other causes of admission in older children’.

Between April 2000 and March 2013, there were 7.8 million unplanned hospital admissions for children younger than 15, with 4.1 million of these short-stay admissions for potentially avoidable infections and chronic conditions.

The reforms in April 2004 saw an 8% increase in short-stay admissions for chronic conditions, in addition to the 3% annually increasing trend, and equivalent to roughly 8,500 additional admissions.

The study notes there was an accompanying decrease in admissions referred by a GP after the changes came in to force, with more children being admitted by hospitals instead.

Though the study did not test a causative link, the 11% increase in children with long-term conditions admitted after the 2004 contract imposition leads the authors to suggest: ‘This development may indicate an adverse impact of financial incentive schemes focusing on chronic conditions.’

Ann Fam Med 2015; available online 11 May

Readers' comments (9)

  • Or may indicate a change caused by " payment for results" in hospitals. Ie and incentive to admit rathert Han treat and send home.

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  • The agenda is to blame the GP not goverment policy or the action of the hospitals,we cannot win(hence the article in the daily wail).The onslaught continues the denegration of GP land continues.

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  • yes we all accept QOF was a bad government policy so why do we still have it?

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  • Look at the way this is being spun on the front page of the daily fail this morning. Says everything you need to know. Stick the knife in and twist it hard. 5 more years of this... Too much, enough enough.....

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  • Professor Maureen Baker, chairwoman of the Royal College of GPs, said: "This research is largely based on ungrounded assumptions - there is no evidence to suggest a causal link between out of hours GP access and either increased emergency attendances or short-stay admissions for children.
    "Any increase is most likely due to some hospital doctors taking a more cautious approach to admitting children for overnight observation, a response to pressure to meet the A&E four-hour target, and a lack of ability to discharge patients back into the community."

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  • @10:23
    Interesting that The Mail hasn't been running too many harsh anti GP stories in the few weeks up to the election, and now it starts its hatred all over again post election, with Jeremy back as Health Secretary. The beast has been unleashed again. We are heading for a nasty time of it.

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  • Introduce qof like mundane incentives in school and parenting. The public health indices are not solely a GP problem.

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  • General Practice is not kitted out for modern patient demands.If you want good paediatric care then train up more community paediatricians and put all of children's primary care in their hands.The funding can come from replacing GPs with Physician Assistants

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  • Come on Alex, you are better than this.

    Look at the primary care sensitive QOF conditions in table 2. Say asthma admissions in 1-4 year olds. Despite a rise in the patient population in the two years studied, asthma admissions FELL from 13,267 in 2000-2001 to 9,796 in 2011-2012 after the introduction of QOF. A primary care success in my view, though may owe something to cleaner air.

    Look at the overall length of stay (fell significantly) and the number of readmissions (rose) and tell me that the two are not related!

    I agree with Maureen Baker. The rise in admissions relates to admission thresholds at the hospital door and the tightening of the A&E 4hr wait target (also 2004), and nothing to do with the introduction of QOF.

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