News / Financial incentives are failing health test

By Seamus Ward

The quality and outcomes framework (QOF) has not led to better prevention from ill health or improved health promotion by GPs, according to a report from the King’s Fund.

The QOF was introduced in 2004 to drive up the quality of general practice by paying for higher performance in the quality of clinical care and management. However, the report, Impact of quality and outcomes framework on health inequalities, said that while the QOF had incentivised practices to improve secondary prevention – for example, by detecting illness – it had failed to encourage improved primary prevention and better public health.

Differences in performance on QOF between the least and most deprived practices have all but disappeared in recent years, but the research found limited evidence that the reward scheme had directly reduced inequalities.

The narrowing of the QOF performance gap between practices may be the result of those in deprived areas becoming better at meeting QOF requirements, rather than having significantly improved their population health, the report said.

Researchers also found that practices in deprived areas have not actively sought to identify new cases or to reach out to patients with certain chronic conditions. This was despite incentives in the QOF to keep a register of patients with these illnesses.

The fund called for revisions in QOF to ensure payments are made to reward population outcomes, such as reductions in emergency admissions (subsequently included in the 2011/12 QOF). The QOF and GP contract must also offer greater incentives for primary prevention, it added.

King’s Fund policy director Anna Dixon, said GP commissioning offered a chance to improve the current incentives and ensure that GPs took responsibility for the health of all their local population.

‘A great deal of money has been invested in providing GPs with financial incentives through the QOF,’ she said. ‘It is disappointing that we have not gained greater return on investment so far in terms of health improvement in deprived areas.’

Eleven quality and productivity indicators have been agreed in the QOF for 2011/12, NHS Employers said. The indicators aim to secure more effective use of resources by rewarding clinically effective and cost-effective prescribing, reduced emergency admissions and hospital outpatient referrals.

These indicators may be extended into 2012/13 if significant progress is made in achieving productivity savings.