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Patients more likely to choose practices with higher QOF points

Patients are more likely to choose GPs who earn a higher number of QOF points, a DH-funded study has found.

The findings by researchers at the University of York’s  Centre for Health Economics, which have been discussed with DH policy officials, concluded that patients are attracted to better performing practices, measured by their QOF points achievement. It also found that patients are more likely to choose practices with a higher number of young, female or European-trained GPs.

However, doctors’ leaders warned that GPs’ workloads are so big that the conclusions could have the perverse incentive of encouraging GPs to lower the quality.

The study - which is still a work-in-progress - looked at just under 1,000 practices covering 3.4 million patients across the former East Midlands strategic health authority area. Researchers used data on patient choice based on QOF, the rate of emergency admissions for ambulatory care sensitive conditions and average patient satisfaction with practices.

They estimated that a practice that increases its QOF score by 10 points will increase the number of patients aged 25 and over who wish to join its list by 163. They calculate that a 10% increase in QOF points will increase demand for the practice by nearly 15%.

The researchers said: ‘Given other practice characteristics, patients are more likely to choose practices which earned more quality points under the QOF pay for performance scheme. This measure of quality predicts practice choice better than the other measures of quality, such as patient satisfaction or [Ambulatory Care Sensitive Conditions] admissions.’

It concluded: ‘Practices seeking to attract patients could do so by raising quality. If the marginal revenue from additional patients sufficiently exceeds their marginal cost so as to cover the costs of higher quality then greater competition in this market could potentially improve quality for patients.

It also stated: ‘We find that patients are more likely to choose practices which are nearer to their home, which have a higher proportion of GPs qualified in Europe, a higher proportion of female GPs, and a lower average GP age. Patients appear to prefer practices with PMS rather than GMS contracts though this effect is weaker than other characteristics. Dispensing status has no effect on patient choice.’

Dr Laurence Buckman, chair of the GPC, told Pulse that GPs were already so overworked and wanted to reduce their workload that they might consider reducing their quality and QOF points in order to reduce patient lists.

He added: ‘That is a dreadful conclusion but the door swings both ways, GPs are so overworked they don’t look at why patients are coming in.  I certainly don’t try to be more or less popular based on QOF points.’

Professor Carol Propper, one of the authors of the report, told Pulse: ‘This paper is a work-in-progress. It research has been partially funded by the Department of Health and we have discussed the findings with policy officials at the DH prior to publishing the findings.’