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It is misleading to conclude the QOF has not improved the population’s health

The conclusions drawn from this paper are misleading. It is looking at differences in QOF scores between different small areas throughout the country, and failing to find a correlation between these differences and falls in mortality rates. 

What is not made clear is that overall the QOF, since it was introduced, not simply in the last few years, has been responsible for considerable change in the ascertainment of high blood pressure, people with heart disease not on cholesterol lowering treatments etc and resulted in the application of uniform standards of care across the country in the management of these long term conditions.  This has resulted in massive improvements. 

The fact is that the differences between well performing practices and badly performing practices are now minor.  Put slightly simplistically, more or less all practices do very well, and this has resulted in an improvement in care.  We have narrowed the gap between the best and the worst, and there are other papers which show this.  Therefore, given the gap is now so narrow between the best and the worst, trying to look at differences in outcomes between the best and the worst to provide a justification of the money spent on the QOF is the wrong approach.  It was never going to find much. 

The correct conclusion to have made is that the QOF has helped to partially overcome health inequalities, and has contributed to the fall particularly in cardiovascular mortality alongside changes in population risk factors, so is money well spent. That we now cannot find any significant differences between good and poor QOF performers is because we are all getting more or less all our QOF points.

Dr Kambiz Boomla is a GP in Tower Hamlets and a senior lecturer in primary care at Queen Mary University London