QOF targets must focus on outcomes GPs can influence

Basing QOF on patient outcomes rather than tick-box processes will fail if outcomes cannot be linked to GPs' efforts, a primary care expert has said.

Stephen Campbell, senior research fellow at Manchester University, said there was little evidence that pay-for-performance schemes such as QOF directly affect patient outcomes.

Speaking at the Healthcare Innovation Expo 2011 in London last week, Dr Campbell said: ‘We see a short-term improvement, but this is impossible to attribute to pay-for-performance due to background noise. Pure outcomes will not find their way into QOF due to attribution issues.’

His comments echo concerns from Dr Colin Hunter, chairman of NICE’s QOF indicator advisory committee.

In his speech, Dr Campbell said QOF had ‘never quite worked out’ whether it was a payment mechanism or a quality improvement scheme.

Patient outcomes are set to be central to monitoring the commissioning performance of GP consortia – they will be held to account against a commissioning outcomes framework. A ‘quality premium’ will then reward good performance.

This approach would be ‘hamstrung’ unless precise business rules are developed, Dr Campbell said. These include details of data extraction from GP systems, performance thresholds, commonality of the outcomes measured, and whether general practice has control over them.

Dr Campbell also expressed concern over plans to introduce more public health indicators into the QOF.

‘There is a GP role to play in delivering that. But I think PCT-type level is right for public health outcomes.’

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