QOF could link to patient benefits and ignore GP workload

Primary care could be made more efficient if QOF points were linked to patient benefits rather than GP workload, research by a member of the NICE QOF team suggests.

BP checks: QOF payment linked to workload
BP checks: QOF payment linked to workload

A study led by Dr Nicholas Steel, who sits on the NICE QOF advisory team, found that pay for QOF targets bears no relation to the gains that result from achieving them. But the GPC defended the framework, arguing that the entire GP contract was workload-based.

The researchers compared financial incentives for QOF indicators to the health gains that would result from hitting them. They found that 'incentives are not aligned with maximising health outcomes', which the DH set out as an explicit aim when reworking QOF in 2008.

Commenting online in BMC Health Services Research, Dr Steel and his colleagues said their findings had important implications for policymakers.

'The lack of an association between the size of the incentive and the expected health gain may risk skewing activity towards areas with high workload but relatively low benefit to health,' they said. 'Other areas which receive little or no incentive may be relatively ignored.'

Dr Steel told GP: 'As QOF evolves, it seems only sensible to align incentives with health gain, especially when the NHS budget is under particular pressure. Our paper shows there is potential for QOF to improve efficiency by aligning incentives with health gain.' He said there was in principle no reason why current incentives could not be more closely aligned.

GPC deputy chairman Dr Richard Vautrey said QOF was not designed to link incentives to health benefits, but to recognise the time GPs spend achieving QOF targets. 'It is a workload-based contract,' he said.

DH spokeswoman said: 'We want to reform the current payment system in the future so that rewards for GP practices are targeted more at improving patient outcomes.

'In the future, the independent NHS Commissioning Board will hold clinical commissioning groups to account for the health outcomes of their local communities.'

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