QOF ‘reduces secondary care costs’

By Lilian Anekwe

The improvements in GP care brought about by the QOF have cut secondary care costs, according to a Department of Health-funded study of the framework's effectiveness.

Leading QOF researchers, who conducted the study on behalf of the Health Foundation, found ‘an interesting relationship between mean practice QOF scores and reduced secondary care costs' – but backed GPs to contribute ‘material gains' towards reduced hospital costs and NHS efficiency savings.

The economic analysis, carried out by researchers from the Centre of Health at the University of York and Imperial College Business School, examined data from 50 million patients in England with eight chronic clinical conditions: asthma, chronic obstructive pulmonary disease, coronary heart disease, diabetes, hypertension, hypothyroidism, mental health and stroke.

It compared yearly QOF scores dating back to 2004/05 with patient-level hospital episode statistics in 2007/08.

Citing stroke care as an example, the study found a 10% increase in mean practice QOF scores achieved over the four-year period cut secondary care costs by £165 million, dwarfing the cost of the incentive payments associated with the QOF score increase.

A single point increase in the QOF stroke score could lead to 2,385 fewer deaths in a year, the research published by the Health Foundation charity concludes.

The report offered a ringing endorsement of the Government's strategy of shifting more work to primary care, concluding: ‘Our research has found an association between achievement of QOF indicators and some measureable reduction in costs for hospital care and mortality outcomes.

‘The research also suggests that QOF attainment in one clinical area could have a positive impact on hospital costs in other clinical areas. Therefore, studies that examine the impact of improved quality by looking at the benefits for only one disease might seriously underestimate the total benefits of that quality improvement.

‘This research makes an important contribution to a number of topical initiatives, including the merits of prevention and early intervention, and shifting care from secondary settings to primary care.'

Professor Martin Marshall, director of research and development at the Health Foundation, a former GP and one of the original architects of the QOF, said the findings were ‘reassuring'.

‘What's particularly interesting here is the relatively short time period between investing in GPs and reduced secondary care costs,' he said.

'This says to NHS planners that over the next five to ten years they might need fewer hospital beds and even stroke units.' Dr Colin Hunter, chair of NICE´s QOF advisory committee and a GP in Aberdeen, said: ‘This is excellent news for general practice and the QOF.

‘It's a high quality report from a good source and seems to show unequivocally the benefit of the QOF approach. These results would concur with international evidence that greater development of primary care lowers secondary care costs.' 'It would probably be wrong to say that the benefits are wholly due to QOF. Even pre-QOF, management was improving. GPs were doing these things previously, but not in such an organised and systematic way. But the QOF has definitely given it an extra "leg up".'

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