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QOF has led to no significant improvement in mortality rates, says study



The QOF has led to no significant improvement in mortality rates for medical conditions covered, a Lancet study has claimed.

Researchers looked at data from 27 high-income countries, comparing death rates for conditions covered by, and not covered by, QOF.

The study, which looked at death rates in the UK between 1994 and 2010, found that QOF was related to a small, not statistically significant, decrease in death rates for heart disease and a small increase in death rates for non-targeted conditions.

It comes as in England, the Government and GPC had agreed to look at ’completely’ getting rid of QOF as early as next year. Meanwhile, in Scotland, the scheme is already largely scrapped.

Despite £5.86 billion being spent on the scheme’s incentive payments in the first seven years of the scheme, ‘QOF was not associated with significant changes in mortality’, researchers said.

They found that in the UK, the mortality rates for conditions in the QOF decreased by four per 100,000 patients, while for conditions not covered mortality rates increased by 12, when compared to the other countries. For ischaemic heart disease, mortality rates dropped by 11.

The paper said: ’Our results show that introduction of the QOF in the UK was not significantly associated with changes in population mortality for disease areas that were targeted by the programme. We recorded that the QOF was also not significantly associated with changes in mortality for disease areas that were not targeted by the programme.

The researchers, from the University of Michigan, University of Manchester and University of York, said that their study ’provides the first cross-national evidence for the effects of pay-for-performance on population health.’

They wrote: ’Extensive research into pay-for-performance programmes has yet to show clear patient benefits.

’The apparent failure of such a large and sustained programme to reduce mortality suggests that faults might exist in the general approach of use of financial incentives to improve population outcomes or in the specific design of the QOF.’

The study said that the effects of improved primary care on death rates could actually be ‘slight’ in comparison with other socio-economic factors. It added that QOF could possibly have improved non-fatal outcomes but the study did not cover those cases.

Commenting on the study, Professor Martin Roland, former GP and professor of health sciences at the University of Cambridge, said the research ’emphasises the importance of a primary care system that provides universal coverage with a strong preventive component and the important role of doctors in advocating for measures to reduce behaviours that lead to ill health and premature death’.

A Department of Health spokesperson said: ’We recognise GPs are under a lot of pressure and have already revised the QOF to remove ten-minute minimum slots for booked appointments, as well as reducing unnecessary paperwork for GPs so that they can spend more time with patients.

’NHS England has agreed to undertake a review of QOF in the coming year, to see how we can best manage the system for the future.’

QOF could be scrapped ‘in its entirety’ by next year

The GPC and the Government have agreed to ’explore’ a complete scrapping of QOF in England, with the framework remaining unchanged for 2016/17.

In Scotland, QOF achievement is no longer linked to practice payments.

Health secretary Jeremy Hunt has repeatedly hinted at the removal of QOF, including telling Pulse last year that he was ‘not a fan’ of such financial incentives. However, he has also indicated that he wishes GPs to continue to record clinical outcomes against the framework.

Somerset was the first area of England to get rid of QOF and work to a local alternative scheme in 2014, with initial evaluation of the project revealing it had not led to impaired clinical outcomes.

The report found that dropping the QOF has freed up GPs to offer patients more holistic, person-centred and co-ordinated care – without any reduction in measures of quality.