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Retiring QOF indicators ‘will lead to worse performance’

By Nigel Praities

Removing indicators from the QOF next year will likely result in a decline in performance by GPs and they may need to be reintroduced, concludes a study published today.

The research – led by QOF adviser Professor Helen Lester – found that while incentives attached to clinical quality indicators in California improved performance, this was then partly reversed after they were removed.

The GPC agreed with the Department of Health to the retirement of eight indicators recommended for removal from QOF by NICE last year, despite earlier claims from negotiators that the removal of the indicators would harm patient care.

The study is published in the British Medical Journal today and looked at the performance of two indicators, for diabetic retinopathy and cervical cancer screening, in 35 Kaiser Permanente medical centres in California. It found performance levels rose when doctors were being incentivised, from 84.9% to 88.1% and 77.4% to 78% respectively. But after their removal from the incentive scheme, performance dropped to 81% and 74% respectively after four years.

The removal of indicators was associated with a decrease in performance of around 3% per year for diabetic retinopathy screening and about 1.6% per year for cervical cancer screening.

The authors concluded that policy makers should think very carefully before removing indicators from programmes such as QOF and should consider making any changes in a ‘stepwise way' rather than through blanket removal.

Professor Lester, professor of primary care at the National Primary Care Research and Development Centre, said: ‘If removal of financial incentives means that performance levels, and therefore, potentially patient care, decline, this may have direct practical implications for policy makers, clinicians and patients.

‘If these findings are confirmed across a wider range of indicators, clinicians will need to think proactively about how they can maintain their previous levels of care if financial incentives are removed for specific clinical areas and policy makers may need to think about reassigning financial incentives if care dips to a previously agreed unacceptable level,' she said.

BMJ 2010; early online

Professor Helen Lester