Demand for QOF overhaul to tackle health inequalities

30 Nov 07

Speaking in the week that the committee announced a wide-ranging inquiry into the issue, Kevin Barron said he was in favour of thrashing out plans for a localised framework.

The inquiry adds to the chances of new measures to gear the QOF to tackle issues such as GP access and the failure of practice based commissioning to achieve local health goals.

Mr Barron said: ‘I’ve always found it quite strange that we have a national framework for GPs when clearly there is no one national pattern of disease burden in the UK.

‘In my area, the disease burden is higher than some areas, yet GPs work on the same QOF. We’re going to be testing that to see how suitable that is either for preventing and managing health inequalities.’

His comments will add to mounting pressure for a rewriting of the QOF, following health minister Lord Darzi's call for ‘greater flexibility for PCTs in setting outcomes that reflect local needs and priorities’.

Pulse exclusively reported in May that local versions of the QOF were being considered to form a central part of the Government's long-term strategy, and were being discussed with NHS Employers and the GPC.

The new inquiry will look at ‘the distribution and quality of GP services and their influence on health inequalities’, focusing specifically at how access, the QOF, and Practice Based Commissioning (PBC) could help reduce disparities.

The inquiry follows hot on the heels of a report published in last week‘s BMJ, reported in Pulse, which found that the QOF was widening health inequalities in general practice.

Professor Julia Hippisley-Cox, co-author of the report, welcomed the inquiry, and said the QOF could be used to ‘incentivise achieving equality’.

Proposals to revamp the QOF from its architect, Professor Martin Roland, revealed by Pulse last week, are expected to be used as evidence in the inquiry. Professor Roland called for changes such as the scrapping of the controversial square root formula and raising the top indicator thresholds to 100%.

Dr Howard Stoate, MP for Dartford and a member of the Committee, said: ‘We’re looking to tease out why it is there is such disparity, and whether there‘s anything that we do in the GP contract that that might put things right.’

However, Sandra Gidley, MP for Romsey and a fellow member of the Committee, said it was ‘rubbish’ to suggest that PBC was currently capable of helping reduce inequalities, saying: ‘GPs and commissioners have enough on their hands working out how to commission the basics properly.’