Older GPs ‘more likely to be poor QOF performers’

By Christian Duffin

Older GPs who do not ‘buy into the modern practice model' and single-handed GPs are most likely to perform very poorly in the QOF, according to a major new analysis of scores at practices across England.

Researchers from King's College London examined QOF scores at more than 8,000 practices between April 2004 and March 2008 and investigated whether these were linked to GPs' ages, genders or ethnicities, the number of full-time equivalent GPs, list sizes or deprivation in the neighbourhood.

They found that the poorest performing practices generally had one or more key characteristics in common – being single-handed, a non-training practice or staffed by older GPs.

Among the 212 poorest QOF performers 57% were singlehanded practices, while 63% had an average GP age of over 55.

Dr Mark Ashworth, a South London GP and senior lecturer at King's College London who led the research, said the statistic raised concerns about the Government's policy of allowing GPs to continue to practice after the age of 70 without additional checks on care quality.

‘I would ask the question about whether there should be a level of QOF below which there is an automatic trigger to some sort of investigation of the practice,' he said.

‘Perhaps some older GPs have different professional values and do not buy into the modern practice model, where practice management is considered so important. GPs might say that's not the reason they went into general practice.'

Dr Ashworth stressed that despite the poor results, many GPs may well be providing good services. He said single-handers' strong point is that they provide continuity of care, which is not measurable by the QOF. Many single-handed GPs might not have the time or enough administrative support to score highly, he added.

Dr Gavin Jamie, a GP from Redcar, Cleveland who runs the QOF Database website, said that a reluctance to use technology may explain why some practices have lower QOF scores.

‘Some older doctors might be less enthusiastic about computers,' he said.

‘There's always a pay-off with QOF, about whether you are prepared to put in that extra effort for the extra rewards. It's often about admin and finding the right codes. If the QOF scores are lower because of admin-related issues, then patients are probably still doing pretty well.'

Poorly performing practices identified in the study typically fell down on clinical indicators relating to depression, mental health and palliative care. Dr Jamie suggested this was because there were ‘paper-shuffling' elements to these indicators that some GPs did not consider important for patient care, and therefore avoided.

The study, published in this month's Journal of Health Services Research and Policy, also revealed that NHS London had more than half of the worst performing practices, while non-UK trained GPs scored better than their UK-trained counterparts after adjustments based on the relative deprivation of patients. Practices with large list sizes per full-time equivalent were not necessarily poor performers.

J Health Serv Res Policy 2011;16:21-27

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