Call for local QoF frameworks

Failure to set up local versions of the Quality and Outcomes Framework could lead to missed opportunities to improve quality and tackle local health priorities, according to a team involved in the UK’s largest local QoF scheme.

Doctors from Imperial College, London, and NHS Hammersmith and Fulham involved in the QoF+ scheme in NHS Hammersmith and Fulham said such schemes had the potential to better tackle local health needs.

The QoF+ scheme was set up by the primary care trust in 2008. It is a five year project costing £2.2m a year and involving 48 additional QoF indicators.

A quarter of the indicators offer additional rewards for achievement above the levels set on 12 national indicators, while the other 36 indicators incentivise preventive action on local health needs.

Areas targeted by the QoF+ scheme include screening for alcohol misuse, advice and support on breastfeeding, tuberculosis screening and disease registers for eczema, psoriasis, rheumatoid arthritis and osteoarthritis

The doctors, writing in the BMJ, say only a few primary care organisations had developed local schemes using existing incentives.

They suggest that, while the demise of PCTs could mean there is less management capacity, GP consortia could offer scope for greater clinical involvement in such schemes.

The authors say current reluctance to set up local incentive schemes could result in missed opportunities to improve quality, encourage innovative service development and tackle local health priorities.

They identify potential benefits as allowing PCOs to set and reward more ambitious targets than those set nationally, providing opportunities to pilot new quality indicators, promoting greater ownership of the quality agenda at local level as well as better targeting to reflect local health needs and to reduce inequalities.

However, the authors warn there are considerable financial, technical and human resource requirements for developing such schemes.

They say NHS Hammersmith and Fulham had to invest in a bespoke IT system because none of the current systems were suitable. They also say £150,000 was required to support indicator development, primary care staff training and programme monitoring.

The authors conclude that widespread adoption of local schemes is unlikely unless the government devolved part of the QoF budget to PCOs for local priorities, expedited plans for a national menu of quality indicators for local use, and developing an IT infrastructure to ensure robust monitoring.