Different outcome measures and mechanisms to measure potential harms caused by the quality framework must be put in place, say authors of an opinion piece in the BMJ.
Evidence-based medicine is at the core of the quality framework, but this standardises treatments and is not a substitute for clinical judgment, they say.
'The quality framework diminishes the responsibility of doctors to think, to the potential detriment of patients, and encourages a focus on points scored, threshold met and income generated,' note the authors, including north London GP Dr Iona Heath.
The framework must shift to measure real outcomes such as diabetes complication rates or the incidence of MI in patients, said Dr Heath and colleagues, who criticised rewards for measuring processes such as lowering BP.
The most marginalised people often have physical and mental health problems, making them difficult to squeeze into the structure of the QOF, they argue. Similarly, the poorest are most likely to have co-morbidities.
These factors increase the likelihood of being exception reported, putting them 'at risk of receiving proportionally less attention' from GPs, says the team. Additionally, GPs working in poor areas are less likely to meet targets to be poorly paid.
But GPC chairman Dr Laurence Buckman said: 'Health improvements are taking place as a result of the QOF will be measurable over a number of years.'
Alastair Henderson, deputy director of NHS Employers, said: 'This criticism is unfounded, with no evidence to show that the QOF has resulted in lower levels of care for any group of patients.'
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