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At the heart of general practice since 1960

QOF has failed to bring benefits for patient care

The GP contract has failed to have the anticipated impact on improving the quality of patient care, two separate Government-funded analyses have concluded.

The findings, which suggest the quality framework has had little if any effect in accelerating the pace of improvement, leave the contract vulnerable to criticism from an upcoming National Audit Office inquiry.

Previous studies had found care had got better since the advent of the QOF in 2004, but the new research suggests GPs were already driving up standards as early as 1998 in the absence of incentives.

In a couple of specific areas – asthma and diabetes – the new contract does appear to have brought about a 'modest acceleration' in standards. But critically for the NAO's analysis of cost-effectiveness, there appears to have been no effect on the rate of improvement of care overall or for coronary heart disease.

A special report published in the latest New England Journal of Medicine by the National Primary Care Research and Development Centre compares the quality of care in 42 nationally representative practices between 1998 and 2005.

Study leader Dr Stephen Campbell, a research fellow at the centre, said: 'The improvement from 2003 to 2005 for indicators for which incentives were provided, compared with those with no incentives, did not differ significantly from the rate predicted on the basis of the trend from 1998 to 2003.'

Overall, the proportion of patients receiving appropriate care rose from 59% in 1998 to 76% in 2003 and 85% in 2005. A second study presented at the Society for Academic Primary Care conference in London last week is similarly positive about GPs' work but potentially damaging for the contract.

Professor Julia Hippisley-Cox, professor of clinical epidemiology and general practice at the University of Nottingham, analysed data from 498 practices on prevalence and target achievement. Professor Hippisley-Cox, who is due to be meeting the NAO soon, told Pulse: 'There is good evidence the changes predated the QOF given the consistent increase since April 2001.'GPs should be congratulated for all the hard work that's been put in.'

Dr Robert Fleetcroft, honorary senior lecturer in primary care at the University of East Anglia, said it was 'near impossible' to determine whether improvements would have continued without the introduction of incentives. 'If you were going up 10% a year, the question is when is that going to plateau and will incentives push that up. The answer is we don't know.'

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