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Gold, incentives and meh

QOF scores mask care inequalities

GPs' high achievement across the board in the QOF is masking acute health care inequalities because of high rates of exception reporting in deprived areas.

A new audit of diabetes care found no relationship between QOF achievement and deprivation for any of the indicators

examined ­ despite large variations in prevalence.

But when the researchers looked at exception reporting they found that rates were significantly higher at practices in deprived areas, by up to three-fold for some indicators.

There were significant differences between the most and least deprived practices for seven of 11 indicators ­ including records of serum creatinine and microalbuminuria.

The findings contradict claims that by promoting high achievement in all areas the QOF was helping to level out health inequalities.

The researchers called for funding to be targeted at practices in deprived areas to fund initiatives such as outreach nurses and provision of transport to surgeries.

Study leader Ms Claire Turner, public health practitioner at Brighton and Hove City PCT, said: 'The main reason [for high exception reporting] would be people not turning up. There's probably also issues around high levels of co-morbidity.'

Ms Turner, who presented the findings last week at the UK Public Health Association annual forum in Telford, Shropshire, added: 'By allowing more deprived practices to achieve at these high levels it means there is investment going in but these people who are hidden may have compromised care.'

Dr Mark Browne, a GP in

Derby and diabetes lead for Greater and Central Derby PCTs, said practices in deprived areas were losing out.

'The really really iniquitous thing is the square root formula. Practices have to work extremely hard in areas with a large ethnic population and they are not incentivised or rewarded. It's devious and iniquitous.'

Dr Rob Barnett, secretary of Liverpool LMC, wasn't sure throwing money at the problem was the answer. 'We would need to have a good understanding of the underlying problem.'

The research will be published in the Journal of Public Health.

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