The real benefit of the quality incentives

To many politicians, members of the public, and of course the media, the quality framework is little more than a box-ticking exercise with the sole purpose of generating huge bonuses for ‘fat cat’ GPs.

But evidence is now starting to emerge that the scheme may actually be of real benefit to patients and the financial well-being of the NHS.

A report by Asthma UK has revealed alarming disparities between the different regions of England when it comes to adding up the numbers of emergency hospital admissions for asthma.

Admissions in the north west, for example, are 65 per cent higher than in the east of England. Drilling down, there are neighbouring PCTs where one has half the national average of emergency asthma admissions, and the other has twice the national average.

The figures relate to 2004, and the geographical differences in admission rates cannot be conclusively explained by the usual mitigating factors, until the introduction of the quality framework that year is also taken into account.

In 2004, practices were able to earn 72 points for hitting the asthma quality targets. And the statistics quoted by Asthma UK show that, in PCTs with high achievement levels, the rate of emergency asthma admissions was 10 per cent lower.

This is very good news for advocates of the target-driven approach to primary care. If the figures stand up to scrutiny, they are evidence of immediate impact from the reorganisation (some would say regimentation) of patient services, backed by financial incentives.

Of course, it fits nicely with the government’s aim of reducing overall hospital admissions by managing more patients in the community. And it also shows the quality framework as a cost-effective intervention (at least in asthma care in 2004), proving that spending in primary care really can lead to savings in hospitals.

Indeed, of the 67,700 asthma admissions that did take place in 2004, the estimate is that 75 per cent could have been avoided, at a saving of £43.7 million.

Maybe it can also be interpreted as another ingenious way in which Tony Blair has managed to ‘save the NHS’? Though we have yet to see the figures for 2005 and 2006.

So does this all mean that there is light at the end of the tunnel for the much maligned quality framework?

Could there be a new era on the horizon when the media will no longer be able to characterise GPs as underworked and overpaid? Don’t hold your breath.

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