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QOF does not improve care and should be replaced, finds official review

NHS ‘should look at other ways’ than QOF to motivate GPs to provide high-quality care for long-term conditions, a study commissioned by NHS England has concluded.

The paper, published today in the British Journal of General Practice, said this comes as a systematic review 'found no convincing evidence' that the QOF had led to improvements in the treatment of long-term conditions.

The review, carried out at the University of Kent, was based on pre-existing, peer-reviewed empirical quantitative research. The study included all randomised controlled trials and longitudinal studies since the QOF was introduced in 2004 (20 in total).

It found the QOF was 'associated with a modest slowing of both the increase in emergency admissions and the increase in consultations in severe mental illness, and modest improvements in diabetes care', but added that the 'nature of the evidence means that the authors cannot be sure that any of these associations is causal'.

There was 'no clear effect on mortality' and 'no evidence that the QOF influences integration or coordination of care, holistic care, self-care, or patient experience'.

The authors concluded: 'The NHS should consider more broadly what constitutes high-quality primary care for people with long-term conditions, and consider other ways of motivating primary care to deliver it.’

But they did warn policymakers to be wary of the consequences of simply removing the pay-for-performance scheme.

The paper said: 'The QOF provides a major component of practice income; if it were abolished, practices would need to be assured of a stable income.

'Losing this is likely to have detrimental effects on patient care and further worsen recruitment and retention in primary care, which is once again in a precarious position.'

BMA GP Committee chair Dr Richard Vautrey has previously told Pulse that the GPC will be negotiating for the QOF to be 'retained but reformed' for next year's contract.

Having previously agreed to review the framework, the GPC U-turned following a vote at this year's LMCs Conference, where delegates decided that ‘disinvestment from QOF is no longer desirable'.

Instead they urged the GPC to agree a revised framework with indicators that are ‘evidence based’ and ‘clinically relevant’.

Commenting on the new study, Dr Vautrey said: 'The reality is that QOF funding is now essential core practice funding without which practices would collapse.

'It funds practice staff, including nurses and vital support staff, who are involved in the da-to-day care of patients, including those with long-term conditions.'

Dr Vautrey said the GPC remained committed to QOF review in England, which would also 'learn' from changes being made in Scotland and Wales.

He added: 'However, we cannot take essential funding from practices to create new incentive schemes that risk destabilising practices.'

The QOF hokey cokey

NHS England has said it is 'committed in principle' to scrapping the QOF after its chief executive Simon Stevens stated that the QOF had ‘reached the end of its useful life’ and would be phased out of the GP contract by 2018.

At the time, the GPC said it supported the move, which was in line with its calls for reduced 'box-ticking and bureaucracy'.

But, despite last year's GP contract agreement explicitly stating that negotiations for 2017/18 would explore the option to completely abolish the QOF no such changes were agreed for this year.

And Pulse recently revealed that the GPC in England has met with NHS chiefs to discuss the introduction of more flexible indicators on diabetes for next year’s contract, casting doubts on whether the framework would be dropped after all.

It comes as Scotland has already dropped the QOF from the GP contract altogether, while GPC Wales and Northern Ireland both negotiated suspensions of the QOF earlier this year to help ease pressure on GPs.

Readers' comments (8)

  • National Hopeless Service

    This headline and this headline; Giving GP practices extra funding 'could cut hospital costs by 10%', say researchers......just makes me want to weep.

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    QOF will probably stay for CQC
    but go for funding Thus a paycut
    win win for gov

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  • We know whats coming next..... since QOF doesnt improve outcomes it will be dropped and so will the funding... Daily Mail will say ' paying doctors more to look after patients is of no benefit' - they will produce a figure stating how much more we've been paid but by the QOF system (As if its some generous get rich quick scheme- they won't mention how some practices couldn't survive without it) but how patients haven't benefitted at all, giving the impression we are greedy and incompetent, Tax Payers Alliance will state in response to this news story (After having dinner with the editors the night before in an overpriced London restaurant - on expenses) that the public they represent are 'outraged' by this 'lack of productivity' and only 'improved efficiency' driven through 'more competition' can improve things as our Lazy NHS doctors are obviously crap, so the voters want more involvement of private providers to come to the rescue as only privatisation is the solution... they won't mention how Virgin trains, for example, now receive more subsidy as a private concern than when it was a nationalised service..... nor mention how much money is being sucked out of the system via PFIs. The public will be brainwashed by the media into believing the spin.... job accomplished.

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  • AlanAlmond

    The whole point of QOF was to micromanage every single aspect of pretty much everything a GP does. Since its introduction at every consultation there has sat the patient, the Dr and a government official called QOF. In my opinion QOF has been the biggest driver of appointment wasting, box ticking, morale destroying stupidity we have faced in the last 10 years. It's also been central to the ever increasing over bearing power of NICE. Everything is lead by some stupid brainless protocol or EMIS template that needs to be fulfilled above everything else we do...or we don't get paid. If QOF goes I would be delighted. The fact that the pathetic BMA thinks we should keep it says more about anxiety that the government would replace it with something even worse or just take away the funding all together, and the BMAs total inability to do anything about it, than anything else.

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  • The idiots who thought out of thought we wouldn't achieve the targets set we did and continue to.They thought they could get one over on the top 1% of A level candidates..I. Wonder what centipede these consultants were.We have been treated with a total lack of respect for what we have sacrificed.Despite our weak union we will have the last laugh.Most of the workforce have a 5-10 year plan most of us will be out of the game then.Remember the out of hours fiasco,when these muppets have finished any primary care service will cost 4x as much and achieve a lot less.The politician reverse Midas touch,anything they touch turns brown and smelly.

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  • I hate predictive text!!!The moment is gone.

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  • When the GPs on the BMA were "opposing" the NHS at its inception the chairman said they were all for better health care but that the worry was there would be three people in every consultation. The patient, the GP...and the government telling the other two what to do. Was he wrong? He who pays the piper calls the tune and I reckon much of what has come about since has been driven by HMG resenting the fact that only by conceding self-employed contractor status (as they did private work for consultants) did the doctors play ball with the NHS. So never mind the efficiency and VFM provided by primary car, this is about control and ideology.

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  • This is such a breath of fresh air raising limitless opportunities to modernise rather than catheterise the profession.
    General practice at its best is run using a simple capitation based system with differential weighting for age, deprivation and complexity.
    That is it...
    QoF has indeed had its day and was often a distraction that undermined,at times, the core, more humanistic elements of general practice (which to deliver has a cost that was never funded) and in many cases and situations QoF hampered the financial viability of the business that is general practice - more QoF = more staff
    A micromanaged system required manpower and as we know the cost of manpower has been part of the problem..... this in part has casused the fall in GP income (from profits).
    With a block budget minimal target funded service you allow the efficient system, that can be general practice, realise its true potential by creating its own un-catheterised, unchained approaches to delivering primary care...

    We should not worry about managing every piece of delivery of care and thus it is time to go to an outcomes based system which does not look at every HBA1C or PHQ9 as the metrics but patient satisfaction, patient activation, mortality and morbidity data over short, medium and long periods...

    If your allow GPs to breathe and flex their own muscles, acknowledging that they know their own populations best, we could save general practice.

    Still have oversight on quality and outcomes but make outcomes and quality the same thing...

    Hope that makes sense

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