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QOF has failed to have impact on UK population’s health, study concludes

The QOF has not led to reductions in premature deaths in the UK population, according to research that showed there was no link between practices’ performance on clinical domains of QOF and local mortality figures.

The study analysed the relationship between QOF scores at 8,647 practices in England in 2011-12 with mortality data for 32,482 local neighbourhoods made up of around 1,500 people.

Deaths from any cause and those related to specific conditions included in QOF – such as diabetes, hypertension and heart failure – declined over the period three to eight years after QOF was introduced, from 2007 to 2012, but the researchers found no evidence of a link between practices’ QOF achievement on clinical domains and either all-cause or cause-specific mortality rates within practice localities.

By contrast, the team found that mortality was influenced strongly by deprivation, as well as being linked to rurality and the proportion of non-White people in the population.

The study’s authors, led by Dr Evangelos Kontopantelis, a senior research fellow at the Centre for Primary Care at Manchester University, reported: ‘We found that overall quality of care provided by practices – as measured by achievement across all clinical QOF indicators – was not associated with mortality rates in their localities for conditions covered by the QOF.

‘There remained no association when potential effects were lagged for up to three years.’

The team concluded: ‘Higher reported achievements of activities incentivised under a major, nationwide pay-for-performance programme did not seem to result in reduced incidence of premature death in the population.’

They did add, however, that is was ‘possible’ that ‘longer term mortality reductions will ultimately accrue’.

BMJ 2015; available online 3 March