'No convincing evidence' QOF helps patients with long-term conditions

Performance-related pay as promoted through the QOF does not improve care of people with long-term conditions and may have a negative impact on patients, researchers have found.

The study, commissioned by NHS England and led by the University of Kent, examined a number of studies assessing how the QOF has affected patient outcomes.

Published in the British Journal of General Practice (BJGP), it concluded there was ‘no convincing evidence’ that the QOF promotes better care and outcomes for people with long-term conditions.

The scheme could in fact have had negative effects on care, it warned, by diverting practices away from care that is not QOF-related and stifling motivation to improve achievement beyond expected levels.

Around 99% of practices in England are part of the QOF, which was introduced 13 years ago in 2004. It accounts for 10-15% of practice income on average – but is due to be phased out, potentially from April 2018.

The GP contract agreement for 2017/18 said that a 'working group' would be examining the future of QOF after April 2018. The QOF is no longer in place in Scotland and practices have not been required to do this work since April 2016.

Long-term conditions care

This latest study said it is unlikely that abolishing the QOF will cause standards to drop significantly – and doing so may allow practices to prioritise other activities, which could lead to better care.

The researchers found the QOF may be associated with some ‘very modest positive effects’ in limited areas, such as slowing the increase in emergency admissions, an increase in consultations in severe mental illness and improving diabetes care

But they found no evidence that the QOF leads to better coordinated care, more holistic care, better encouragement to self-care or improved patient experience or involvement in decisions. It also appeared to have no effect on mortality rates.

The authors said: ‘The QOF is unlikely to advance progress towards the vision of the Five Year Forward View for the care of long-term conditions.

‘To deliver the aims of the Five Year Forward View, the NHS should consider more broadly – beyond what is measured by the QOF – what constitutes high-quality primary care for people with long-term conditions, and consider managing performance on this basis.

‘In the context of a demoralised primary care workforce, it is important also to consider ways other than financial incentives to motivate primary care teams to deliver high-quality care.’

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