University of Manchester researchers linked QOF scores from 8,000 GP practices in England to all-cause mortality data and data on premature deaths to check whether performance in the framework was reflected in the health of local communities.
But the researchers found that 'overall quality of care provided by practices - as measured by achievement across all clinical QOF indicators - was not associated with mortality rates in their localities for conditions covered by the QOF'.
Improvements in performance incentivised by the QOF were not associated with a reduction in premature mortality, the researchers said, suggesting that 'the impact of the incentive scheme has fallen far short of previous estimates'.
Narrow focus on QOF
GPC deputy chairman Dr Richard Vautrey criticised the findings. 'It's unhelpful to have a narrow focus on QOF as an incentive scheme and miss the more important fact that QOF funding is an essential part of practice funding that pays for staff who work in the practice,' he told GP.
'Whether a practice achieves against a narrow set of thresholds misses the point that the staff in practices, GPs, nurses and support staff are all working to deliver the best possible holistic care to their patients.'
The researchers, writing in the BMJ, said that deprivation, rurality and proportions of non-white people within populations were far more closely linked to mortality than variations in standards of care between GP practices.
'The apparent lack of large effect on mortality over the medium term may suggest that the QOF may not have been an optimal investment of health service resources,' they wrote.
'If incentive schemes continue to be used in primary care with the intention of improving population outcomes, indicators will need to be reconsidered and better aligned with evidence on which activities contribute to reduction of premature mortality.'
However, the researchers conceded that 'it is possible that there have been significant population benefits in terms of reduced morbidity incidence or improved quality of life, and that longer-term mortality reductions will ultimately accrue'.