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QOF care distortion prompts pay fears

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GPs' pay and pensions come under pressure as new research questions value of the QOF

The GP contract is systematically distorting care by driving neglect of conditions that do not carry incentives, 'disturbing' new research has claimed.

Two evaluations, conducted in parallel and one of them Government-funded, found the QOF had 'knock-on effects' on conditions without payments attached.

GPs warned that the controversial findings – which have already been presented to the Treasury – could have serious implications for future contract negotiations.

In a week of fierce press criticism over pay, they said the research could be used by the Department of Health to 'make GPs look rich and lazy'.

A study in Scotland found consultation rates in the first year of the QOF rose substantially for diabetes and asthma, but fell by up to 12 per cent for depression and anxiety, which did not then carry points.

Interviews with doctors, nurses and practice managers revealed widespread concerns over 'crowding out' of some conditions.

Study leader Professor Bruce Guthrie, professor of primary care medicine at the University of Dundee, said: 'Although QOF has increased activity for incentivised diseases, it also appears to have reduced activity for un-incentivised disease – an unintended consequence. This is rather disturbing.'

A matching study undertaken in England by the National Primary Care Research and Development Centre has also found 'unintended effects' of the QOF, and will shortly be presented to the department.

Professor Stephen Harrison, professor of social policy at the centre, told Pulse: 'Our study certainly showed QOF has effects other than those intended. There are knock-on effects. It should be pause for thought.'

GPs told Pulse the findings rang true, but that they feared for the consequences.

Dr John Brett, a GP in Finchley, north London, said: 'At my practice, we're thoroughly fed up with the QOF because it does lead to a distortion in care. It can lead to bizarre activity.'

Dr John Guy, a GP in Hatfield Peverel, who has been involved in analysing QOF data for Essex, warned: 'The Government is trying to make us appear very rich and very lazy.'

The GPC feared the department would use the research as a stick to beat GPs. But GPC chair Dr Hamish Meldrum refuted suggestions the QOF was merely shifting workload rath-er than increasing it.

The QOF effect

• Diabetes – consultations up 11.3 per cent in men and 5.9 per cent in women

• Asthma – up 7.6 per cent in men and 7.9 per cent in women

• Depression – consultations fell 10.9 per cent in men and 11.9 per cent in women

• Anxiety – down 1.7 per cent in men and 7 per cent in women

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