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QOF does not improve care and should be replaced, finds official review

NHS ‘should look at other ways’ than QOF to motivate GPs to provide high-quality care for long-term conditions, a study commissioned by NHS England has concluded.

The paper, published today in the British Journal of General Practice, said this comes as a systematic review ‘found no convincing evidence’ that the QOF had led to improvements in the treatment of long-term conditions.

The review, carried out at the University of Kent, was based on pre-existing, peer-reviewed empirical quantitative research. The study included all randomised controlled trials and longitudinal studies since the QOF was introduced in 2004 (20 in total).

It found the QOF was ‘associated with a modest slowing of both the increase in emergency admissions and the increase in consultations in severe mental illness, and modest improvements in diabetes care’, but added that the ‘nature of the evidence means that the authors cannot be sure that any of these associations is causal’.

There was ‘no clear effect on mortality’ and ‘no evidence that the QOF influences integration or coordination of care, holistic care, self-care, or patient experience’.

The authors concluded: ‘The NHS should consider more broadly what constitutes high-quality primary care for people with long-term conditions, and consider other ways of motivating primary care to deliver it.’

But they did warn policymakers to be wary of the consequences of simply removing the pay-for-performance scheme.

The paper said: ‘The QOF provides a major component of practice income; if it were abolished, practices would need to be assured of a stable income.

‘Losing this is likely to have detrimental effects on patient care and further worsen recruitment and retention in primary care, which is once again in a precarious position.’

BMA GP Committee chair Dr Richard Vautrey has previously told Pulse that the GPC will be negotiating for the QOF to be ‘retained but reformed’ for next year’s contract.

Having previously agreed to review the framework, the GPC U-turned following a vote at this year’s LMCs Conference, where delegates decided that ‘disinvestment from QOF is no longer desirable’.

Instead they urged the GPC to agree a revised framework with indicators that are ‘evidence based’ and ‘clinically relevant’.

Commenting on the new study, Dr Vautrey said: ‘The reality is that QOF funding is now essential core practice funding without which practices would collapse.

‘It funds practice staff, including nurses and vital support staff, who are involved in the da-to-day care of patients, including those with long-term conditions.’

Dr Vautrey said the GPC remained committed to QOF review in England, which would also ‘learn’ from changes being made in Scotland and Wales.

He added: ‘However, we cannot take essential funding from practices to create new incentive schemes that risk destabilising practices.’

The QOF hokey cokey

NHS England has said it is ‘committed in principle’ to scrapping the QOF after its chief executive Simon Stevens stated that the QOF had ‘reached the end of its useful life’ and would be phased out of the GP contract by 2018.

At the time, the GPC said it supported the move, which was in line with its calls for reduced ‘box-ticking and bureaucracy’.

But, despite last year’s GP contract agreement explicitly stating that negotiations for 2017/18 would explore the option to completely abolish the QOF no such changes were agreed for this year.

And Pulse recently revealed that the GPC in England has met with NHS chiefs to discuss the introduction of more flexible indicators on diabetes for next year’s contract, casting doubts on whether the framework would be dropped after all.

It comes as Scotland has already dropped the QOF from the GP contract altogether, while GPC Wales and Northern Ireland both negotiated suspensions of the QOF earlier this year to help ease pressure on GPs.