Report claims QOF boosts inequality

The QOF may perpetuate health inequalities and should be reformed to improve care, according to a report that will feed into the King's Fund inquiry into general practice.

Dr Dixon: lack of support issue

Continuity of care has been reduced since the QOF was introduced and this may have negatively affected health inequalities, the report said.

The report, Tackling Health Inequalities in General Practice, was commissioned as part of the King's Fund GP inquiry.

Evidence showed that health inequalities were reduced effectively by improving continuity of care, it says. But this has fallen under new GMS, the report said, and QOF performance remains lowest in deprived areas.

This imbalance in QOF achievement may have, therefore, blocked efforts to tackle health inequalities, it argued.

GPC deputy chairman Dr Richard Vautrey expressed doubts over the claims. 'It counters well-established evidence that QOF has reduced the inequalities gap,' he said. 'Continuity of care is not related to QOF: it's due to changes in demography and access targets.'

The report warned against removing exception reporting, however. It said that although this may increase coverage to more vulnerable patient groups, it could cut QOF earnings and negatively affect the doctor-patient relationship.

Dr Michael Dixon, NHS Alliance chairman and a member of the inquiry's expert panel, said: '[GPs in deprived areas] have to work hard for QOF points - maybe this is something to recognise in future.'

White Paper plans to scrap practice boundaries could also damage GPs' relationship with the local community, important in reducing inequalities, it said.

Dr Vautrey said: 'It's one among many concerns about practice boundaries. We believe it will be to the detriment of quality patient care.'

A second report into management of long-term conditions said general practice played a 'pivotal role' in diabetes care, which had markedly improved.

But dementia care has been held back by a lack of specialist services. Dr Dixon said: 'A big issue is the lack of support, which makes looking after someone with dementia very difficult.' 

General Practice Inquiry

Health inequalities report:

  • Worse continuity of care may have blocked efforts to reduce inequalities.QOF should focus more on disease prevention.
  • Consortia could use GP data to track inequalities.

Long-term conditions report:

  • GPs key to diabetes care.
  • Arthritis care is highly variable and sub-optimal.
  • Lack of specialist dementia services to refer patients to.
  • Need for clinical education and training on depression.

Source:King's Fund reports

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