QOF 'worsens inequalities and can impede GP care'

The quality framework (QOF) has been criticised for impeding GP standards of care, as well as worsening health inequalities, claim UK doctors.

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.'

rachel.liddle@haymarket.com

BMJ 2007; 335: 1,075-6

Comment below and tell us what you think 

 

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

Vaccination tracker

UK COVID-19 vaccination programme tracker

GPs across the UK have led the largest-ever NHS vaccination programme in response...

RCGP chair Professor Martin Marshall

Hand PCNs control of primary care infrastructure funding, says RCGP

CCG funding for primary care infrastructure should be handed to PCNs when the bodies...

Professor Martin Marshall and Talking General Practice logo

Podcast: RCGP chair Professor Martin Marshall

Talking General Practice speaks to RCGP chair Professor Martin Marshall.

Dr Chaand Nagpaul

In-house review not enough to stop 'unjust' GMC referrals, warns BMA

Doctors' leaders have repeated calls for a full independent review of the GMC referral...

Coronavirus

How widespread is long COVID in the UK?

Millions of people in the UK are living with long COVID. GPonline looks at the data...

COVID-19 vaccination sign

GP contract for autumn COVID-19 booster campaign due shortly

GP practices in England will be invited shortly to sign up for the COVID-19 autumn...