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Managers admit evidence to support continuation of QP indicators is limited

Exclusive: Managers have struggled to provide any evidence that QOF indicators designed to reduce emergency admissions and A&E attendances have had any impact, according to responses to an NHS Employers survey seen by Pulse.

The responses to an NHS Employers survey show most managers agree that the quality and productivity indicators had an impact on reducing outpatient referrals, but not in improving GP access or driving down emergency admissions.

The results call into question the Government’s decision to retain the QP indicators in its offer for the 2013/14 GP contract. The Department of Health said it would review their effectiveness after that.

But twelve responses from four CCGs and thirteen PCTs to a NHS Employers survey this year suggest that this review may find little evidence to suggest they have been effective at reducing hospital activity.

Seven out of twelve said that they had measured a reduction in outpatient referrals in 2011/12, and the same number said that they agreed the QP scheme had contributed to reducing referrals that year. All said it was too early to measure the effect on referrals in 2012/13.

A response from the NHS Arden Cluster said: ‘To some extent this has been a contributing factor, however other changes have impacted also.’ but Greenwich CCG said ’ When the data for 11/12 is compared to the previous year for the areas chosen in Greenwhich, there has been an increase.’

Only four respondents said they had experienced a reduction in emergency admissions in 2011/12, and three said the QP indicators had reduced emergency admissions.

All of the respondents said they could not tell whether the scheme had any impact yet on emergency admissions in 2012/13. The response from North Durham Shadow CCG said: ‘Possibly, it’s hard to tell. The 30-day readmissions policy may have had some effect also.’

NHS South East Essex said: ‘At this stage, it is more likely that the impact we have seen to date is attributable to QIPP schemes rather than the QP indicators.’

Similarly, none of the respondents were able to say whether the accident and emergency QP indicators had led to improved access to primary care services in 2012/13.

More generally, managers agreed the schemes had improved engagement between practices and that GP engagement with QP indicators was ‘very positive’ and their implementation was only ‘moderately difficult’.

But they admitted more time was needed to complete the indicators and that there had been delays in practices receiving sufficient information for pathways to be implemented.

Dr Andrew Mimnagh, chair of Sefton LMC, said the responses showed the indicators were inherently flawed as they measure things outside of the control of GPs.

He said: ‘The people who make the decision about this may be in the belief that if they run them long enough they’ll get the answer they want.

‘The feedback on the ground is that the QP schemes showed up how many things are outside of a GP’s control.’

GP negotiator Dr Chaand Nagpaul said: ‘The QP indicators were never designed to prove their worth through a measurable outcome or to be crudely associated with reductions in referrals.

‘There is a huge variation in how they’ve been implemented locally, there are coding differences in hospitals, and a multiplicity of factors which affect hospital admissions and referrals so it’s not possible to extract their influence.’

He added that the GPC had agreed to retain the indicators in this year’s contract as there was ‘no reason to withdraw the scheme’.

A spokesperson for NHS Employers said: ‘The results of the survey were discussed with the GPC in respect of contract changes for 2013/14. We do not comment on the detail of such negotiations.’

A Department of Health spokesperson said: ‘Our proposals for the GP contract are all about improving care for patients. The Quality and Productivity indicators will continue to incentivise practices to work with commissioners to improve the management and integration of patient care across primary and secondary care.’

‘Steps will be put in place to reduce the administrative burden these place on practices. GPs will work with the NHS Commissioning Board and Clinical Commissioning Groups from April to make sure improvements take place. The Commissioning Board will review the use of these indicators ahead of 2014/15.’

 

What NHS Employers asked 

Have the QP indicators had an impact on outpatient referrals? 7/12 respondents agreed

Have the QP indicators had an impact on emergency admissions? 3/12 respondents agreed

Have the QP indicators for accident and emergency attendances helped to improve access to primary care services in your area? 0/12 were able to answer ‘yes’. Most said it was too early to tell or that the question could not be answered.

Readers' comments (3)

  • 'Managers admit' is a little sensationalist - many QOF leads have been saying this from the start.

    It is optimistic bordering on naive to expect independent contractors to review primary care access as part of the QP indicators and conclude anything other than access is sufficient!

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  • Pardon my ignorance, but after returning to this country from Australia, an infinitely happier place to practice and receive primary medical care, I am still mystified as to the purpose of QOF.

    It appears to be a system that distracts GPs from their main task, gives them something to do while their sphere of competence is eroded and at the same time does nothing whatsoever to reduce the incidence or prevalence of chronic or acute disease. What's more it looks very expensive to run.

    Can anyone enlighten me?

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  • Regarding request for enlightenment on:-
    "It appears to be a system that distracts GPs from their main task, gives them something to do while their sphere of competence is eroded and at the same time does nothing whatsoever to reduce the incidence or prevalence of chronic or acute disease."

    I suspect it is you should be giving us the enlightenment ,as that looks a pretty acurate global assessment to me.
    There are limited examples of subsets that buck the trend , but the overall package, especially the 2013 indicators would fit that observation nicely.

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