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Removal of QOF indicators does not undermine performance, new study reveals

GP practice performance remains stable for QOF indicators even after they are removed from the framework, reveals a new study that could support further reductions in the framework.

The BMJ study of patients in 644 practices found that the introduction of indicators improved performance in those areas, but crucially the outcomes remained stable even after the indicators were withdrawn.

GP leaders said that this study supported a move this year to reduce the size of the QOF by 40%, as practices in some areas of the country ditched reporting QOF completely.

The study, led by researchers from the University of Manchester, looked at 11 indicators that were withdrawn during the study period of 2004/05 to 2011/12, extracted from the Clinical Practice Research Datalink and covering 13,772,992 patients in total.

It aimed to ‘assess the effect that removing the incentives for these indicators from the QOF scheme had on subsequent performance’ – both on performance as measured by that particular indicator and on performance as measured by related indicators.

It concluded: ‘Following the removal of incentives, levels of performance across a range of clinical activities generally remained stable. This indicates that health benefits from incentive schemes can potentially be increased by periodically replacing existing indicators with new indicators relating to alternative aspects of care.’

Performance around all the 11 indicators the researchers examined remained relatively stable, the study showed.

It said: ‘The indicators for monitoring blood pressure (CHD5, DM11, and Stroke5), HbA1c (DM5), and cholesterol in patients with diabetes (DM16) all showed no statistically significance differences between observed and expected levels following removal. However, the cholesterol monitoring indicator for patients with coronary heart disease (CHD7) showed a significantly lower observed mean in 2011/12 compared with expectation (−1.19%, −1.56% to −0.81%).’

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The researchers concluded: ‘In this study, we modelled the effect of withdrawing a range of incentives on subsequent performance under a comprehensive, national scheme for primary care providers. For five of the six indicators withdrawn in 2011/12, we found no significant effect on subsequent short term performance.

‘For one of the two indicators removed in April 2006, adjusted levels in 2011/12 were not significantly different from 2005/06 levels. However, estimated differences were relatively small across all indicators, including for the two indicators that showed statistically significant deterioration.’

Dr Richard Vautrey, deputy chair of the GPC, said it was no surprise that GPs continued good practice even after the indicators were withdrawn.

He said: ‘As practices develop and embed their systems, then if they think something is sensible to continue, they will continue it. That should be a lesson which those who are concerned about the removal of some of the indicators in the coming year should be reassured by.

‘The Government have been clear that they want to reduce the size of QOF and the emphasis on micromanagement and box-ticking, and that is something that we would welcome engagement with the Government on in the future. The negotiations this year have been a step in the right direction, have been welcomed by the profession and there is further work that could be done to take that one step further.’