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GPs go forth

QOF 'failing to close health gaps', experts warn

By Lilian Anekwe

The QOF has only had minor benefits for reducing health inequalities, and has failed to justify the money spent on it, a major new review concludes.

Its authors warn the Government will only deliver on its pledge to narrow inequalities if ‘radical action' is taken to reshape the QOF to target it at deprived populations.

That action should include raising thresholds to 100%, implementing much ‘tighter' rules on exception reporting, and developing indicators aimed directly at hard-to-reach groups, they said.

Researchers at the prestigious Centre for Health Economics in York reviewed a string of economic analyses of the value for money delivered by the QOF.

They concluded though it focused GP activity in some clinical areas - including coronary heart disease, stroke and smoking cessation - ‘the small measured gains that can be attributed to the QOF do not seem to justify the large expenditure'.

Instead, they said it should be used to differentially fund practices in deprived areas.

‘Some interventions could be targeted more directly at disadvantage – at the lowest income patients within each GP practice, or at practices in the most deprived areas within each PCT.'

‘Practices could be encouraged to reach the more difficult-to-serve patients if maximum QOF payments were made for 100% of achievement with tighter exceptions.'

The centre is working with the National Primary Care Research and Development Centre to develop and pilot new indicators for inclusion in the 2011/12 QOF.

Its study came as the Department of Health published new figures on health inequality and claimed it was ‘broadly on course' to meet targets for narrowing the gap set for 2010.

But Dr David Epstein, lead author of the new report and research fellow at the University of York, insisted NICE may need to take ‘radical action' to bridge the inequality gap.

‘Addressing health inequalities may require more radical action, with some departure from the NHS principle of equal treatment for equal clinical need, towards differential treatments for different social groups.'

‘NICE could address health inequalities by lowering the cost-effectiveness threshold for initiatives that have an impact on disadvantaged groups.'

Dr John Canning, secretary of Cleveland LMC and a GP in Middlesbrough, said: ‘There is a need to incentivise work in areas of deprivation but I don't think the QOF is the way to do it.'

‘The life expectancy of the ward my practice is in is among the lowest in the country, but Middlesbrough gets very good QOF scores. That's not the issue - it's about practices being resourced in other ways.'

The QOF has so far had only minor benefits in reducing health inequalities, according to a new review The QOF has so far had only minor benefits in reducing health inequalities, according to a new review The Department of Health's pledges on health inequalities

• Reduce mortality rates from heart disease, stroke and related disease by 40%, cancer by 20% and suicide and undetermined injury by 20% in people under 75
• Reduce health inequalities by 10% as measured by infant mortality and life expectancy at birth
• Reduce adult smoking rates to 21% or less
• Halting the year on year rise in child obesity in under 11s
• Reducing the under-18 conception rate by 50%

Source: HM Treasury Public Service Agreements, 2004

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