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QOF may have distorted GPs’ priorities

QOF led to small detrimental effects on non-incentivised areas of care

Louise Prime

Friday, 01 July 2011

Aspects of care that are not incentivised by the Quality and Outcomes Framework have suffered as GPs have concentrated more on those areas in which they can earn financial incentives, say researchers on bmj.com. Overall, they found that the quality of care improved after QOF was implemented.

Tim Doran, from the National Primary Care Research and Development Centre in Manchester, and others used the General Practice Research Database (GPRD) to analyse trends in quality of care in 500 UK general practices, before and after QOF’s introduction. They examined data on performance indicators for 42 activities, of which 23 were incentivised by QOF and 19 were not.

After QOF began there was a general improvement in quality for all activities. However, the patterns of improvements differed between incentivised and non-incentivised activities.

During the first year of QOF, there was a significant improvement in quality of care for incentivised activities, but this then plateaued in the second and third years.

The study’s authors suggest a possible explanation for this: “Most practices attained achievement rates above the maximum achievement thresholds … for most incentivised indicators in the first year, and thereafter had no financial incentive for further improvement.”

In contrast, in its first year QOF had little apparent effect on the rate of improvement in non-incentivised activities – but by QOF’s third year, quality of care in these areas was significantly worse than would have been predicted by pre-QOF trends.

The study’s authors suggest that incentives “seem to have had some detrimental effects in the longer term, possibly because of practices focusing on patients for whom rewards applied.”

They warn that an unintended potential consequence of financial incentive schemes is that they could lead to neglect of non-incentivised aspects of patient care.

The researchers conclude: “These findings show some important limitations of financial incentive schemes in health care, and the importance of monitoring, as far as possible, activities that are not incentivised in addition to those that are when determining the effects of such schemes.”

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