QOF scores survive prevalence rises

Sanjay Tanday looks at the reasons why practices across the UK have varied in their clinical quality score success.

GPs across the UK have 'risen to the challenge' of a tougher quality framework and maintained their average quality framework performance for this year.

It was feared that the addition of harder indicators to the revised quality framework, coupled with the loss of 50 access points, would affect quality scores.

However, the average English practice earned 954 points, down just six points from last year, allowing for its loss of access points.

In Scotland and Wales, practices also dropped an average of six points in the 12 months to 31 March 2007, scoring 970 and 947 points respectively.

In Northern Ireland, scores remained constant at 978 points (allowing for the access cut). But the high scores become more impressive when viewed in light of the rise in disease prevalence across the UK.

Figures released by the Information Centre revealed that the prevalence of hypertension, which is worth 83 quality points, increased in England for the third year running. It was recorded at 12.5 per cent for 2006/07, 0.5 per cent higher than the previous year.

In Scotland hypertension rose from 11.7 to 12.5 per cent over the past three years.

In Wales the situation is worse, with the prevalence of hypertension rising by nearly 2 percentage points over the past three years to reach 14.3 per cent. But GPs across the UK still scored highly in the hypertension domain, particularly in England, where GPs hit 98.3 per cent of targets.

Highest score
Overall, GPs in Northern Ireland achieved the best clinical quality scores, hitting 99.5 per cent of targets for hypertension and 98 per cent of cancer targets. Their performance may have been helped by lower rises in disease prevalence than in the rest of the UK. Figures for 2006 show that hypertension prevalence was 11.6 per cent in Northern Ireland.

Dr Brian Dunn, chairman of the GPC in Northern Ireland, said: 'I am delighted and proud to say that again Northern Ireland GPs have achieved the highest results in the UK. They have proved how hard they are working to achieve these targets.'

Dr Dunn added that the quality framework was particularly important in Northern Ireland, which has one of the highest rates of CHD in the world.

GPC Wales chairman Dr David Bailey, said the performance of Welsh GPs was 'remarkable' considering they were facing a 14-15 per cent higher prevalence than the rest of the UK. It has long been known that prevalence of cancer patients in Wales is high due to a high proportion of older people. This is due to younger generations moving away from the Welsh countryside.

His Scottish counterpart, Dr Dean Marshall said: 'Our government should be proud of the achievements of general practice and the great strides they are making towards improving how the NHS manages the care of patients with chronic disease.'

By lowering BP and controlling hypertension, GPs can reduce the number of heart attacks, one of Scotland's biggest killers, said Dr Marshall.

Lowest score
GPC England chairman Dr Laurence Buckman said that GPs had again risen to the challenge and fared remarkably well. However London practices performed less well. This may be due to the high prevalence of mental health problems in these areas.

Targets in the mental health domain have proved to be the most difficult to meet.

The lowest scoring PCTs in England - Brent, Enfield, Newham and Camden - are all found in London. Camden is the lowest scoring PCT in the country, achieving just 85.9 per cent of targets. Camden PCT has the highest prevalence of mental ill health in England at 1.2 per cent.

North Shields GP Dr Dave Tomson, who has an interest in mental health, said mental health problems tended to be more common in urban areas and in areas with high unemployment and migration.

Disease prevalence (%) by quality domain 2006/7

CLINICAL AREA
ENGLAND
SCOTLAND
WALES
N.IRELAND
CHD
3.5
4.5
4.3
4.2
Heart failure
0.8
0.9
1.0
0.8
Stroke and transient ischaemic attack
1.6
2.0
2.0
1.6
Hypertension
12.5
12.5
14.3
11.6

Diabetes mellitus

3.7
3.4
4.2
3.1
COPD
1.4
1.8
1.9
1.5
Epilepsy
0.6
0.7
0.7
0.7
Hypothyroid
2.5
3.1
3.1
2.8
Cancer
0.9
0.9
0.9
0.8
Palliative care 0.1
0.1
0.1
0.1
Mental health 0.7
0.8
0.7
0.8
Asthma
5.8
5.5
6.5
5.8
Dementia
0.4
0.6
0.4
0.5
Depression 01
unavailable
7.2
7.6
6.6
Depression 02
unavailable 6.2
7.3
6.5
Chronic kidney disease
2.4
1.8
2.3
2.3

Atrial fibrillation

1.3
1.3
1.6
1.3
Obesity
7.4
7.0
9.6
8.0
Learning disabilities
0.3
0.4
0.3
0.3
Smoking indicators
unavailable
20.4
22.3
19.0

Source: UK Government

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