QoF architects call for changes

The architects of the Quality and Outcomes Framework (QoF) have called for a raft of changes to the scheme as the House of Commons Health Committee prepares to consider how QoF could be used to reduce health inequalities.

Prof Martin Roland, director of The National Primary Care Research and Development Centre, led work on developing a system of GP clinical targets which was the basis for the creation of the QoF nearly four years ago.

The NPRDC has now published a review of the QoF which it has submitted to the Department of Health with ten recommended changes to the scheme.

The NPRDC report states that there is justifiable evidence for new clinical areas to be added to the QoF and suggests that some indicators could be removed from the scheme on a rotating basis, as it states that the size of the QoF should not increase inexorably. It says any new indicators added should first be piloted.

It is also recommended that the overall proportion of GP income dependent on QoF should not increase. They add: “Although it is too early to be sure, it may be that the proportion of overall practice income dependent on the QoF should reduce in future. No other country experimenting with quality incentives is tying as large a proportion of income to quality of care.”

The authors say that while QoF shows poor value for money in the short term, since care was already improving rapidly in many of the disease areas, it suggests that the mechanism for an ongoing programme of quality improvement is unique amongst developed countries and the UK is regarded as a leader on quality initiatives.

On the whole the report says that there is no evidence of GPs gaming the system for exception reporting, but adds: “The focus on exception reporting should not be on whether to abolish it or not, but on more detailed scrutiny of practices which have unusually high rates of exception reporting. At present, PCTs are hampered in this because IT systems have not been set up to allow reasons for exception reporting to be routinely reported.”

Other recommendations on QoF in the report include a call for changes to the way disease prevalence is treated, in the way patient surveys are carried out and a call for a review of the organisational indicators.

Next year MPs from the health select committee will look at the QoF as part of their inquiry into the role the NHS and in particular primary care and public health services can play in reducing health inequalities.

Keith Barron, chair of the Health Committee, told GP newspaper Pulse: ‘I’ve always found it quite strange that we have a national framework for GPs when clearly there is no one national pattern of disease burden in the UK.

‘In my area, the disease burden is higher than some areas, yet GPs work on the same QOF. We’re going to be testing that to see how suitable that is either for preventing and managing health inequalities.’

The inquiry follows the publication of a paper in the BMJ two weeks ago questioning the value of QoF .

The BMA’s General Practitioner Committee and NHS Employers are currently in negotiations about possible changes to the QoF for April 2008.

Fiona Barr