The think tank said QOF had ‘promoted a medicalised and mechanistic approach to managing chronic disease which does not support holistic patient centred care or promote self-care and self-management.’
It said QOF had ‘not necessarily resulted in changes in clinical activity, improved health outcomes or reduced health inequalities’.
Well-resourced practices, which performed well, were better rewarded financially by the QOF than poor-performing practices which needed the investment, the report also argued.
The NHS has ‘paid a princely sum for activity that was already taking place’ the report said.
The King’s Fund said primary care needs to ‘radically re-orientate’ from a focus on the patient in the surgery to a focus on population health and the needs of all registered and unregistered patients.
Lead researcher and director of policy at the King’s Fund, Anna Dixon, said: ‘The development of GP commissioning provides an opportunity to improve the current system of incentives to ensure practices take responsibility for population health; not just treatment of the patients in front of them’.
The QOF was criticised for not encouraging GPs to case-find. ‘Practices need to reach out to individuals and find ways of providing services to those patients who are less likely to attend the practice,’ the report said .
A number of recommendations for changes to the QOF were included in the report. These included more incentives for primary prevention and rewards for population outcomes, such as reducing emergency admissions.
The development of other pay-for-performance frameworks may help to redress any imbalance, it said. GP commissioners could also reduce health inequalities by ensuring that deprived practices are sufficiently rewarded in order to reduce health inequalities, it said.