QOF scores hit by patient survey

Standards remain high but GP leaders feel falling scores could mislead patients. Sanjay Tanday reports.

Laurence Buckman

If GPs were hoping that the latest QOF scores would provide a welcome morale boost amid the pressures of organising seasonal and swine flu jabs, they will have been left deflated by the results.

The average score for practices in England fell by 13.8 points to 954.2 for 2008/9.

In Northern Ireland, practices achieved the best scores in the UK, averaging 973.1 points for 2008/9. But this was still down on the 986.7 points in the previous year.

In Scotland, there was a slight fall in achievement from 982.2 points in 2007/8 to 972 points in 2008/9, while in Wales practices averaged 956 points in 2008/9 compared with 973 in 2007.

Wiltshire GP Dr Gavin Jamie, a QOF statistics expert, warns that the slump could cost the average practice in England £1,800. But a closer look at the scores reveals that GPs actually achieved more points for the clinical domains in 2008/9 than in 2007/8.

High achievements
Particularly impressive are the improvements made in traditionally hard-to-achieve indicators such as depression, mental health and palliative care.

In England, for example, prevalence of depression recorded by GP practices increased from 12.8 per cent in 2007/8 to 13.1 per cent for 2008/9.

But practices still improved their performance, scoring 92.8 per cent of the available 33 depression points compared with 90.6 per cent in 2007/8.

Scores for the depression indicators also rose across the rest of the UK.

North Shields GP Dr Dave Tomson, who has an interest in mental health, says that the scores are proof that GPs are identifying more cases of depression.

'This goes against the long-held view that GPs often miss cases of depression,' he said.

'GPs are using assessment tools to monitor severity which is a good thing. It should enable GPs to avoid over-medicalising patients who do not have depression.'

GPC chairman Dr Laurence Buckman says that the dip in scores should not detract attention from the excellent performance of GPs.

'The continuation of high scores in the clinical domain shows that patients are still receiving extremely good care from their GP practice,' he said.

'Much of this work is preventative, meaning patients are benefiting from early diagnosis and treatment.'

Dr Buckman says changes to the patient experience survey are to blame for the lower scores, and warns that they could give a misleading impression of the overall standard of general practice.

'Practices got very similar, high patient satisfaction results to last year's patient experience survey, yet this year they have lost points and resources.

'It means that if patients look at their practice's QOF results they could end up with the impression that the quality of the practice, and patients' satisfaction with it, has declined, when this is not likely to be the case.'

Dr Brian Dunn, chairman of GPC Northern Ireland, adds: 'In general practice, if practices did not achieve 90 per cent satisfaction in the patient experience survey, the practice lost money.

'Some practices lost substantial amounts and consequently may have to reduce doctor and clerical staff hours, making access worse.'

Just 17.4 per cent of practices in England in 2008/9 scored maximum points for the patient experience domain,compared with the 94.5 per cent of practices that achieved maximum points in 2007/8.

But there could be good news on the horizon. Changes to the way prevalence is calculated, which saw the square root component removed, were introduced in April in a move that could also help to boost the QOF income of some practices.

'The square root will not affect the scores, it only comes into effect in translating points into cash. High prevalence practices will do well and low prevalence practices worse in cash terms, but the points score remains the same,' says Dr Jamie.

Future changes
A lowering of the targets for the PE7 and PE8 patient experience indicators for practices that hit their swine flu vaccination uptake levels could also help practices to boost their scores next year.

Practices that achieve the uptake levels will earn a 10 per cent drop in the upper thresholds and 20 per cent in the lower thresholds for PE7 and PE8.

'QOF scores should increase next year if the PE7 and PE8 thresholds drop, although this is in the hands of the swine flu virus and how disruptive this is to practices,' says Dr Jamie.

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