Quality framework fails to cut heart disease risk

The quality framework is failing to reduce cardiovascular risk because it measures certain factors, UK experts have claimed.

Performance-related pay for tackling heart disease must be focused on treatment and prevention rather than measuring risk factors, say researchers from the community health department of the University of Dundee.

Treatment of risk factors, rather than their measurement, reduces risk, they argue.

Currently, 15 per cent of quality framework payments come from measuring cardiovascular risk factors. Across the estimated 11,000 GP practices in the UK, that is equivalent to around £200 million of NHS funding.

Rather than improve clinical outcomes, the introduction of the quality framework has led to 'therapeutic inertia', the researchers wrote in the BMJ.

The argument was backed in an accompanying editorial by Professor David Wald, a consultant cardiologist at Bart's Hospital.

'The treatment and prevention of cardiovascular disease is becoming a series of isolated tasks predicated on financial rather than clinical value,' he wrote.

A simpler strategy with more focused incentive payments should be considered by the quality framework expert panel for the 2008 contract, he said.

The expert panel has heard oral evidence and is due to make its final recommendations this autumn.

Surrey GP Dr John Pittard, member of the Primary Care Cardiovascular Society, said: 'The QOF is a dumbed-down version of medicine and I think most of us realise that.'

But he added: 'It is much better than what we had before.'

Dr Pittard denied there was therapeutic inertia because the quality framework does improve clinical outcomes. But he said targets should be tougher, with points awarded when 100 per cent of patients reached targets.

'The only area of the quality framework where you'd say there is some inertia is at the margins.'

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